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Effective Leadership During 
Times of Transition 

1994 Urban MCH Leadership Conference 

September 18-21, 1994 



Office of Minorify Health 

Resource Center 

PG Box 37337 

Washington, DC 20013-7337 




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O 

00 
00 



Conference Highlights 



MCHB 

Maiemal and Child Health Bureau 



CityMatCH 



CDC 

CENTERS FOR DISEASE CONTROL 
AND PREVENTION 



/V1H^(^JPZ.<S^ 



Effective Leadership During 
Times of Transition 



Highlights of the 1994 

Urban Maternal and Child Health 

Leadership Conference 



Magda G. Peck, Sc.D. 

Harry W. Bullerdiek, M.P.A. 

Joan E. Rostermundt 

Co-Editors 



Published by 

CityMatCH 



Cite as: Peck, M.G., Bullerdiek, H.W., Rostermundt, J.E. (1995). Effective 
Leadership During Times of Transition: Highliglits of the 1994 Urban l\/laternal and 
Child l-lealth Leadership Conference. Omaha, NE: CityMatCH at the University of 
Nebraska Medical Center. 

Effective Leadership During Times of Transition: Conference Highlights is not 
copyrighted. Readers are free to duplicate and use all or part of the information 
contained in this publication. In accordance with accepted publishing standards, 
CityMatCH requests acknowledgement, in print, of any information reproduced in 
another publication. Inclusion of a work in this publication does not imply agreement 
or endorsement of the principles or ideas presented. This disclaimer is on behalf of 
CityMatCH, the Maternal and Child Health Bureau and the Centers for Disease Control 
and Prevention. 

CityMatCH is a national organization of urban maternal and child health programs and 
leaders. CityMatCH was initiated in 1988 to address the need for increased 
communication and collaboration among urban and maternal and child health programs 
for the purpose of improving the planning, delivery, and evaluation of maternal and 
child health services at the local level. CityMatCH, through its network of urban 
health department maternal and child health leaders, provides a forum for the 
exchange of ideas and strategies for addressing the health concerns of urban families 
and children. CityMatCH also has developed a centralized information base about the 
current status of maternal and child health programs and leaders in major urban health 
departments in the United States. For more information about CityMatCH, contact 
Magda Peck, CityMatCH Executive Director, Department of Pediatrics, University of 
Nebraska Medical Center, P.O. Box 982170, 600 South 42nd Street, Omaha, NE 
68198-2170, Telephone (402) 559-8323. 

Published b y: Single copies available at no charge from: 

CityMatCH at the National Maternal and Child Health 

University of Nebraska Medical Center Clearinghouse 

Department of Pediatrics 8201 Greensboro Drive, Suite 600 

600 South 42nd Street McLean, VA 22102 

Onnaha, NE 68198-2170 (703) 821-8955, Ext. 254 
(402) 559-8323 

The 1994 Urban Maternal and Child Health Leadership Conference was supported in 
part by grant number MCJ-31 7760-01 from the Maternal and Child Health Bureau, 
Health Resources and Services Administration, Public Health Service, U.S. Department 
of Health and Human Services and grant number R13/CCR7 10741 -01 from the 
Centers for Disease Control and Prevention. Highlights of this conference were 
prepared by CityMatCH under grant number MCJ-31 7760-02 from the Maternal and 
Child Health Bureau, Health Resources and Services Administration, Public Health 
Service, U.S. Department of Health and Human Services. 

Y-iA) printed on recycled paper 



Table of Contents 



Acknowledgments v 

Co-Sponsors and Funders vi 

I. WELCOMING REMARKS 1 

Len Foster, M.P.A. 

Co-Chair, 1994 Urbar) MCH Leadership Conference 

Deputy Director of Public Health 

Orange County Health Care Agency 

Santa Ana, CA 

OPENING REMARKS 2 

Ciro V. Sumaya, M.D., M.P.H.T.M. 

Administrator 

Health Resources and Services Administration 

U.S. Public Health Service 

Rockville, MD 

II. SELECTED PLENARY PRESENTATIONS 

URBAN CHILDREN IN NEED: RESPONSIVE 

AND RESPONSIBLE LEADERSHIP 5 

Margaret A. Hamburg, M.D. 

Commissioner of Health 

New York City Department of Health 

New York, NY 

NATIONAL, FEDERAL, STATE. AND LOCAL APPROACHES 

TO IMPLEMENTING THE CHILDHOOD IMMUNIZATION INITIATIVE 

State Leadership In Immunization 11 

Donald Williamson, M.D. 

State Health Officer 

Alabama State Department of Health 

Montgomery, AL 

VIOLENCE AND PUBLIC HEALTH: 

PROBLEMS TO POLICIES 15 

The Honorable Ellen Anderson 

Minnesota State Senator 

Minnesota Legislative Commission on 
Children, Youth & Family 

Minneapolis, MN 

LOCAL PUBLIC HEALTH LEADERSHIP 

IN TIMES OF TRANSITION 19 

Meredith Tipton, M.P.H. 

Director 

City of Portland Public Health Division 

Portland, ME 



III. SELECTED TOPICAL WORKSHOP PRESENTATIONS 

SCHOOL-BASED CLINICS AND LOCAL HEALTH DEPARTMENTS 

The Denver Experience 27 

Paul Melinkovich, M.D. 

Associate Health Director, Community Health Services 

Denver Department of Health & Hospitals 

Denver, CO 

TB REEMERGES IN URBAN COMMUNITES: IMPLICATIONS FOR MCH 

The Case of Orange County 28 

Hugh F. Stallworth, M.D. 

Health Officer & Director of Public Health 

Orange County Health Care Agency 

Santa Ana, CA 

The Case of Garland 29 

Grace Rutherford, M.S.N. 
Medical Coordinator 
City of Garland Health Department 
Garland, TX 

The Case of New York City 30 

Gary Butts, M.D. 

Deputy Commissioner 

New York City Department of Health 

New York, NY 

WOMEN'S HEALTH 1994: THREE HEALTH ISSUES OF CONCERN TO WOMEN 

Women's Health: Colposcopy Services 32 

Margaret Gier, R.N.C., M.S. 

Manager, Women's Health Programs 

Tri-State Health Department 

Aurora, CO 

iV. CityMatCH SPOTLIGHTS MCH "SUCCESS STORIES" 33 

V. CLOSING REMARKS 35 

Carolyn Slack, M.S., R.N. 
Chairperson, CityMatCH Board of Directors 
Administrator, Family Health Services 
Columbus Health Department 
Columbus, OH 

VI. PROFILES OF SUCCESSFUL URBAN MCH PROGRAMS 

Cities Included in 1 994 Profiles 37 

1994 Profiles of Urban Health Department Initiatives 38 

1 994 Profiles Submitted 42 

VII. APPENDICES 

A. 1994 Conference Planning Committee 21 1 

B. 1994 Conference Program 213 

C. 1994 Conference Participants 224 

CityMatCH Publications Order Form 242 



Acknowledgements 

Some say the Fifth Urban Maternal and Child Health Leadership Conference held in the Fall 
of 1 994 in Washington, D.C. was the best one yet. Of this I am certain. Urban maternal and 
child health leaders from city and county health departments nationwide came together for 
professional development and networking. While they commented widely on the thrill and 
productivity of being together, the hard work that went into putting the conference on did not 
go unnoticed. A magnificent team of conference organizers, coordinators, and administrators 
did a stellar job once again. 

CityMatCH is fortunate to sustain a small, excellent staff in the Section on Child Health Policy, 
Department of Pediatrics at the University of Nebraska Medical Center (UNMC) in Omaha, 
Nebraska. CityMatCH Administrative Technician, Joan Rostermundt, handled logistics with 
grace and efficiency. Conference Coordinator, Harry Bullerdiek, applied his managerial talents 
in such a way that things just had to go smoothly. Coordinator of Special Projects at 
CityMatCH, Elice Hubbert, lent her expertise to the Profiles, Small Workgroups, and 
Spotlights. Additional staff assistance came from Diana Fisaga and Chris Kerby. And the 
CityMatCH staff had lots of help. Conference materials were designed by Helen Gloeb and 
Joe Edwards at the UNMC's Department of Biomedical Communications. Printing came 
through under the direction of Mark Watson at UNMC's Printing and Duplicating Services. 
The National Center for Education in Maternal and Child Health's wonderful conference 
organizing team - Paula Sheahan, Susana Eloy, Kate Ryder, Sue Hutchings, and Jennifer 
Kehoe - handled on-site logistics without a flaw. 

Conference Co-Chairperson Len Foster, Deputy Director of Public Health for the Orange 
County Health Care Agency in Santa Ana, CA, did a marvelous job of leading the CityMatCH 
family. A hard working and creative Conference Planning Committee shaped the program, 
helped secure effective speakers and guided us through the planning process. Patricia 
Tompkins, the Maternal and Child Health Chief of the District of Columbia Department of 
Human Services, and her terrific staff again arranged an excellent tour of D.C. Area programs. 
As always, we are indebted to our many funders and co-sponsors whose support is 
undeniably essential. 

CityMatCH's mission is to enhance the ability of maternal and child health programs at the 
local level to improve the health and well-being of children and families in urban areas. This 
conference goes a long way in allowing this mission to be fulfilled because it fosters the 
active participation of the MCH directors, who take the time to renew their commitment to 
urban MCH and their colleagues nationwide. I acknowledge, with great appreciation and 
gratitude, the hard work of every individual who makes the special connections within the 
CityMatCH family happen. 



Magda G. Peck, Sc.D. 

CityMatCH Executive Director & CEO 

Co-Chairperson, 1994 Urban MCH Leadership Conference 



1994 Urban Maternal and Child Health Leadership Conference 
Co-Sponsors and Funders 



Sponsored by 

CityMatCH 

with assistance from the 
National Center for Education in Maternal and Child Health 



Funded by 

Maternal and Child Health Bureau, HRSA, DHHS 

Centers for Disease Control & Prevention - Division of Reproductive Health 

March of Dimes Birth Defects Foundation, National Office 

University of Nebraska Medical Center 

Co-Sponsored by 

Association of Maternal and Child Health Programs 

Association of State and Territorial Health Officials 

Centers for Disease Control and Prevention - Division of Reproductive Health 

March of Dimes Birth Defects Foundation, National Office 

Maternal and Child Health Bureau, HRSA, DHHS 

Maternal and Child Health Section, APHA 

National Association of Community Health Centers 

National Association of County and City Health Officials 

National Governors' Association 

National League of Cities 

U.S. Conference of Local Health Officers 

U.S. Conference of Mayors 



VI 



Welcoming Remarks 

Fifth Annual CityMatCH Conference 



Sunday 

September 18, 1994 



Len Foster, MPA 

Co-Chair, 1994 Urban MCH Leadership Conference 
Deputy Director of Public Health 
Orange County, CA 

It is my pleasure to welcome you to 
this fifth annual Urban MCH Leadership 
Conference. 

I am pleased to see both so many 
familiar faces from previous meetings, 
and so many new MCH leaders to this 
tremendous learning environment. 

As local MCH leaders we spend much 
of our time dealing with the details of 
program operations and management 
issues. Personnel, space, financing, 
and the ever increasing demands on our 
infrastructure. These are awesome 
responsibilities and ones which require 
constant tending. 

Added to this are the realities of 
managed care, national health care 
reform, low immunization levels, 
violence, HIV, the resurgence of 
tuberculosis, and many other issues. 
The challenge seems, at times 
overwhelming - No one can succeed. 

That is precisely the point of the 
CityMatCH organization. When it was 
created six years ago, it was in 
recognition of the reality of our times. 
As local MCH leaders we share many 
common experiences, face many of the 
same challenges, and have learned 
many of the same painful lessons. No 
one of us has all the solutions. 
CityMatCH was visualized as an 
organization which could assist local 
MCH leaders to learn from each other - 
to share the wealth of knowledge and 
experience which is represented by our 
members. 



The theme of this year's conference is "Effective 
Leadership During Times of Transition." It is my view 
that this theme reflects two basic transitions which 
directly effect all local MCH leaders. 

The first transition is the one represented by managed 
care and national health care reform. There is a 
palpable level of anxiety among many local MCH 
leaders about what this transition means for them and 
their traditional responsibilities and funding base. How 
can local health departments compete with the private 
sector? Who is going to pay for the unique care 
provided by public health programs? What will happen 
to my clinics? 

The other transition I view as philosophical. The 
Hebrew word "Tshuva" literally means to return. When 
applied to present day public health "Tshuva" can 
mean returning to our roots. To take a step back from 
the overwhelming one-on-one patient care 
responsibilities which face each of us every day, and 
begin again to view the community in its entirety as our 
patient. In my opinion, this is the more important 
transition. 

Effective leadership is essential for us to be successful 
in making these transitions. Leadership assumes many 
forms, and it varies from community to community and 
situation to situation. All of us exert leadership. The 
test of effective leadership is how well it works. 
During the next three days you will have the 
opportunity to explore a variety of leadership styles and 
examine examples of leadership which was successful, 
and perhaps a few which were not. It will be up to 
each of us to sift through the information presented 
and to discover those elements which have the most 
meaning to us as individual MCH leaders within the 
context of our own community. 

CityMatCH and this conference are about sharing. Do 
not forego the opportunities to interact with your 
colleagues from across the country. There will be 
opportunities for you to meet your colleagues from 



communities of similar size. There will 
be opportunities for attendees from the 
same federal region to meet together as 
well. Use these times and others to 
establish contact with your peers and 
to build networks from which to draw 
continued support when you return 
home. 



I would like to take this opportunity to express, on 
behalf of CityMatCH, and the Conference Planning 
Committee, my appreciation for the support which we 
have received from the numerous co-sponsors, 
including the Maternal and Child Health Bureau, 
Centers for Disease Control and Prevention, March of 
Dimes, National Center for Education in Maternal and 
Child Health, Association of Maternal and Child Health 
Programs, National Association of County and City 
Health Officials, and many others. 



Opening Remarks 



Sunday 

Septennber 18, 1994 



Giro V. Sumaya. MD., M.P.H.T.M. 

Administrator, 

Health Resources and Services Administration 

U.S. Public Health Service 



I'd like to add my welcome to this fifth 
annual urban MCH Leadership 
Conference sponsored by CityMatCH. 
It is, indeed a pleasure for me to be 
with you this afternoon, and it's good 
to see so many [new, familiar] faces. 

I'd like to take this opportunity to 
express my thanks to all of you who 
were involved in coordinating this 
conference. You've done an excellent 
job. HRSA's Maternal and Child Health 
Bureau is proud to sponsor this year's 
conference with the Centers for 
Disease Control. Additional funding 
comes from the National March of 
Dimes Birth Defects Foundation and the 
University of Nebraska. 



partnership is in place, and communication and 
collaboration efforts are clearly underway. It seems 
appropriate to shift the focus now to leadership. 

This year's theme, "Effective Leadership During Times 
of Transition," will begin to address concerns that face 
us all in a time of potentially dramatic change and in a 
climate of increasing need and decreasing resources. 
Many questions loom large: 

♦ Are there enough strong, skilled leaders who can 
design, implement and evaluate effective 
interventions? 

♦ Is there access to timely and reliable data to 
monitor your efforts and plan for the future? 

♦ Where will the new money come from? 



This group has grown significantly 
since 1990. Nearly 50 of you came 
together at that first conference to 
build the urban MCH network--and to 
begin sharing information about dealing 
with the health needs of children and 
their families in cities across the 
country. Over the last four years, 
representatives from about a growing 
number of cities have met to continue 
the dialogue about what works, what 
doesn't, and why. Now, the 



♦ How can we create collaborative efforts with State 
and Federal MCH colleagues instead of arguing 
over limited resources? 

These and many other questions are being addressed 
at this conference, and I wish you continued success 
in grappling with these issues. 

And as you deal with these challenges, I want you to 
be assured that the President Clinton, the Secretary 
Shalala, the PHS, HRSA, and the Maternal and Child 
Health Bureau are committed to the health and well- 



being of urban children and their 
fannilies. We demonstrate this 

commitment in support for a variety of 
initiatives that target or involve 
American cities~Dr. Nora has alluded to 
many of these. 

Clearly, the "Healthy Start" initiative is 
stimulating local and state collaboration 
to deal with the complex problem of 
infant mortality. These kinds of 
collaborations will assure the longevity 
of Healthy Start long after the initial 
five-year period. Those cities that are 
funded need continued encouragement, 
support and guidance. To those cities 
that have not been funded--l encourage 
you to continue the process of needs 
assessment and interagency planning 
and collaboration. 



This conference is one place to do that, to find out, for 
example, about alternate sources of funding to sustain 
these activities in communities that haven't been 
funded yet. The Federal government must work with 
communities that receive Healthy Start funds to 
integrate Healthy Start efforts with other MCH-related 
activities in local health departments and community 
health centers. And we must reassure local 
communities that investments in Healthy Start and 
other special initiatives are not taking critical resources 
away from existing MCH programs. 

Urban MCH programs are the front line partners with 
State and Federal MCH efforts. No one knows that 
better than you. As a pediatrician, I applaud your 
efforts to improve access to care, to promote infant, 
child and adolescent health, and to address all the 
other urban health concerns which make an enormous 
difference to families and children. 

Your efforts also are of national significance. Whether 
we achieve the Year 2000 Objectives for the Nation 
depends largely on your success in our nation's cities. 



Urban Children in Need: 

Responsible and Responsive Leadership 

Margaret A. Hamburg, M.D. 

Commissioner 

New York City Department of Health 



Monday 

September 19, 1994 



I have been asked this morning to 
provide a local perspective on the 
health needs of urban children and 
families, and to offer some thoughts on 
how, together, the public and private 
sectors can most effectively seek and 
implement solutions. The task before 
us is not an easy one. We all know 
that health is but one of an array of 
many serious problems that confront 
our nation's children and youth, 
problems such as inadequate 
education, family disruption, 
homelessness, drug abuse, violence ... 
poverty. All of these issues are terribly 
important and very intertwined, and 
perhaps no where can these multiple 
influences be more clearly and 
poignantly witnessed than in a major 
urban center such as New York City. 

In order to give dimension to the 
challenges we face, I would like to 
begin with some statistics: 

• Approximately 1 .8 million children 
and youth between the ages of 0- 
1 9 live in New York City. 

• About 60% of these individuals are 
Black or Latino. 

• According to the last available 
census data, at least 1/3 of New 
York City children live in single 
parent families and the figures are 
probably higher. Sadly, an 
increasing proportion of children 
have lost both parents to the 
overlapping epidemics of AIDS, 
substance abuse and violence. 

• And poverty is on the rise. Today, 
more than 40% of children in New 



York City are living in families below the poverty 
line and another 20% are near poor, making a total 
of 60% of children in our City who live well below 
the standards of the middleclass. 

• Related to this, approximately 1/3 of New York 
City children are receiving Medicaid and nearly 
another 1 /4 are uninsured. 

Against this demographic backdrop, let me mention a 
few indicators of the health status and health needs of 
New York City children today: 

• Infant mortality, a traditional measure of child 
health and society overall, is about 30% higher 
than the national average. What is more, in certain 
of our poorest neighborhoods, the rates are 
substantially higher, for example, an astounding 26 
per 1000 live births in Central Harlem last year. 
Correspondingly, there are marked racial disparities 
in infant mortality, with rates among blacks being 
about twice that for whites. 

• Very much linked to infant mortality are the 
problems of maternal substance abuse and AIDS. 
The crack/cocaine epidemic that began in the 
mid-1 980s has taken a terrible toll on mothers and 
their children. Happily, the use of crack appears to 
be declining, but the problem of maternal drug use, 
both cocaine and heroin, not to mention legal drugs 
such as alcohol and tobacco, remains severe. 

Importantly, drug use has been a gateway for HIV 
transmission to mothers and their children. Some 1 in 
83 mothers who give birth in New York City are 
HIV-positive, and close to 80% of pediatric AIDS cases 
are due to injection drug use - either by the mother or 
her sex partner. Strikingly, over 90% of pediatric AIDS 
cases are Black or Latino children. High rates of 
congenital syphilis represent an additional serious 
health concern, also closely associated with maternal 
drug abuse. 



• Although prenatal care cannot 
prevent all disease and deaths in 
infants, we know that adequate 
prenatal care can have a strong, 
positive impact on birth outcome 

and is cost effective. 
Nonetheless, a large percentage of 
births in New York City, perhaps as 
many as 15%, occur to women 
who reportedly received late or no 
prenatal care. 

• Our health care delivery system 
also fares poorly when you look at 
immunization. A recent survey of 
immunization status of 
preschoolers in New York City 
found that only 40% of the 
children had complete 
immunizations by age two. In 
recent years, we have seen the 
consequences of this 
underimmunization in the form of 
serious measles outbreaks, as well 
as whooping cough, rubella and 
mumps. 



rank extremely high among the causes of trauma 
and death. 

• Particularly striking in the 15-19 age group, is the 
fact that the major cause of death is homicide. 
There are approximately six murders per day in 
New York City, and violence, like virtually every 
health indicator, disproportionately burdens poor, 
minority individuals. If current trends continue 
unabated, it is estimated that a young black male 
growing up in New York City has about a one-in-25 
chance of being murdered before he lives out his 
adult years. 

Looking not at death but at serious illness; hospital 
discharge data indicate that children in New York City, 
across all age groups, experience rates of 
hospitalization greater than the national average. 

Asthma presents a good example. For reasons that 
remain unclear, rates of childhood asthma in New York 
City, and certain other geographic areas, primarily 
urban centers, are markedly higher among Blacks and 
Latinos. And in New York City, higher admission rates 
for childhood asthma are more than double the national 
average. 



Moving on to the later childhood years, 
for the majority of New York City's 
children, childhood remains an 
apparently healthy time. Nonetheless 
many serious health problems exist, 
and importantly, health related 
behaviors are being established for the 
future. 

Mortality rates are perhaps not the 
most relevant indicators of health 
status among children and adolescents, 
because thankfully, the numbers are 
relatively low, but the leading causes of 
death do provide some important 
insights and reflect some disturbing 
trends: 

• Leading causes of death among 
younger children reveal that the 
major causes are preventable 
injuries and AIDS. Among children 
in the older age groups, injuries, 
intentional and unintentional, also 



Clearly, improved access to primary care would help to 
reduce these numbers. As you know, too often poor 
children in New York City, and other cities, use 
emergency rooms as their primary care provider; and 
too often this results in problems not being addressed 
until it too late, until disease has substantially 
progressed, and until a potentially preventable 
condition requires hospitalization. 

Nonetheless, it is estimated that in New York City there 
is a gap in the primary care services available to 
children of at least 1 million visits. Looking at the gaps 
in primary capacity in another way, a survey done 
several years ago in New York City found that in nine 
low-income communities in the Bronx, Manhattan, and 
Brooklyn, home to 1.7 million people, there existed 
only 28 physicians practicing genuine primary care. 

Other important gaps in services exist, for example, in 
family planning and prenatal care, especially for poor 
women. Important gaps also exist in the number and 
type of mental health services needed and available. 

Clearly, for those children who suffer frequent bouts of 
acute illness, as well as those with chronic physical 



problems, there is an increased 
likelihood of behavioral and social 
problems. But beyond that, we must 
recognize that adequate attention to 
the needs of children requires that 
health care deal equally with 
psychosocial and physical disease. In 
New York City, like in many urban 
centers, large numbers of children live 
in environments where sources of 
stress, anxiety and depression abound. 
What are the implications for health 
when a child lives in a community 
where the streets are unsafe, or where 
home-life is disrupted by drugs or 
violence or both? 

These are difficult issues to sort out, 
and made more complicated by the fact 
that many of the problems, their roots 
and their solutions are intimately 
intertwined with problems that fall 
outside the traditional province of 
medicine and public health. Clearly, 
there is much we can do to better 
provide needed health services to 
children. But, at the same time, a 
complex array of social and economic 
factors, including poverty, drug abuse, 
family disruption and inadequate 
education greatly influence the health 
of our children. 

So how do we begin to address these 
serious, pressing problems? How can 
we begin to meaningfully improve the 
calamitous state of children's health in 
so many of our urban centers? And 
what are the respective roles of the 
private and public sectors toward this 
end? While the list of statistics and 
disease indicators I just gave certainly 
masks the human face of the problem 
and cannot give us an accurate overall 
picture of the health, or ill health, of 
children, I think that they help to 
illustrate for us several salient themes, 
perhaps imperatives: 

1) The over-riding importance of 
prevention; 



2) The need to more effectively, and equitably, deliver 
basic health care services that we know make a 
difference; 

3) The need to address present needs and realities in 
the lives of poor children and their 
families,including inadequate access and lack of 
quality care, but also social disadvantage and 
economic deprivation, while at the same time 
working toward the basic right of health care for 
every child and a system of services that makes 
that right a reality; and, 

4) The urgent need to press on in addressing these 
problems, despite the terrible fiscal crises 
enveloping so many of our cities. 

These concerns, and hopefully commitments, emerge 
quite clearly from the data, and I believe that they 
pretty much speak for themselves. Yet, I want to 
underscore their importance, and their interconnection, 
as well as to identify some of the future directions in 
which we should be guided. A quick glance at the 
numbers confirms that the majority of ills we are 
struggling to surmount are potentially preventable (in 
terms of either preventing onset of disease or disease 
progression or both) with appropriate primary care and 
preventive health strategies. 

Not only can we save lives, but we also can save 
money. You are probably all aware of the estimate 
that every dollar invested in immunization saves some 
$14 in medical costs, yet why is it that New York City 
and the rest of the nation, continue to have 
immunization rates lower than those in many 
developing nations? Similarly, we know that prenatal 
care is both cost-effective and essential for improving 
the health of mothers and infants, yet again our efforts 
are distressingly poor, and in turn, our rates of infant 
mortality a matter of local and national shame. Why is 
it that asthma, a condition that can be effectively and 
relatively inexpensively managed on an outpatient 
basis, accounts for more than 10% of hospitalizations 
for New York City children? 

The problem is that we have not invested in the kinds 
of preventive and primary care services that we know 
make a difference, and we have not applied all of our 
current medical knowledge and tools to address the 
problems at hand. 



Sadly, nowhere is this more apparent 
nor more acute than in New York City, 
a city that can boast one of the 
greatest concentrations of 
sophisticated biomedical institutions 
and affiliated clinical facilities found 
virtually anywhere on earth, including 
seven medical schools, 75 hospitals, 
nearly a third of a million health care 
workers and annual health care 
spending of some $30 billion dollars. 
Nowhere are the fruits of modern 
medicine more in evidence than in New 
York City's concentration of premier 
medical institutions, yet so many of 
New York City's communities speak to 
our egregious failures. 

Given the magnitude of both the human 
and fiscal crisis to which we must 
respond, it is obvious that an essential 
element of an effective urban strategy 
to improve child health must be to 
improve access and build capacity to 
delivery primary care and clinical 
preventive services to all who need 
them. 

An important part of this is of course 
financial and current machinations here 
in Washington suggest that the much 
desired national health reform goals of 
universal coverage and a minimum 
benefits package including preventive 
services may be illusory. Nonetheless, 
on a local and state level there are 
examples of where we have made 
some notable gains in terms of 
expanding and extending coverage for 
children, and there are opportunities to 
do more. 

With respect to financing, an 
additional, important real world hurdle 
is to ensure that kids who are eligible 
for Medicaid or other such programs 
actually get enrolled in the current 
system of financing health services. A 
surprising number are not enrolled, and 
the barriers to registration are many: 
slow, frustrating bureaucratic forms 
and procedures; separate, often distant 



sites; language barriers; transportation and child care 
issues; fluctuating employment status, and many other 
reasons. 

An important first step is to reduce the complexity of 
the process. I am pleased that New York City, largely 
thanks to the efforts of the Children's Defense Fund 
and a committed cadre of child advocates and 
government officials, the Department of Health and 
others are embarking on a trial program to introduce a 
simplified form (from 30 pages plus to about five). 
Though admittedly a small step, I believe that it will 
result in enormous improvements in Medicaid 
enrollment. 

Yet, we all know that improved access is more than 
just financial coverage. Beyond financial concerns, 
overcoming barriers to care will require appreciation of 
and attention to such issues as supportive services (eg. 
patient education and social services) and certain 
enabling services (such as help with transportation, 
child care, language translation and cultural sensitivity). 
In addition, home care, as well as active outreach in 
many communities, are essential adjuncts to ongoing 
patient care, particularly for children and families with 
special needs. 

And perhaps most fundamentally, we need to 
strengthen and expand primary care capacity. 
Although many factors contribute, one of the most 
profound obstacles to primary care faced by New 
Yorkers is unfortunately a lack of doctors and other 
critical health care providers. We also must continue 
to build the facilities needed to deliver 
community-based primary care. It had been my hope 
that national health care reform would offer the 
opportunity to develop the much needed incentives to 
increase training of primary care providers and dollars 
for infrastructure building. However, since the 
prospects for meaningful reform grow increasingly dim, 
we must aggressively examine other strategies for 
achieving these important goals. 

In this regard, New York City has put in place an 
exciting program that holds great promise. The 
program is called the Primary Care Development 
Corporation (PCDC), and it is a not-for-profit 
corporation designed and instigated by city 
government, but now free-standing with foundation 
support than can offer low cost, tax-exempt capital 
financing for primary care providers, through a 
financing mechanism that includes the city offering 



credit support and the creation of a 
development pool. The first round of 
awards was just made to 1 6 providers, 
targeting the most underserved 
communities throughout the city, and 
reflecting an array of provider types, 
including hospitals, community health 
centers and some community/provider 
partnerships. 

We are very enthusiastic about this 
program, and optimistic that over the 
next year as a result of this program 
we will see significant expansion of 
primary care and in the communities 
where it most vitally needed. 
Improving the health of children and 
youth requires that we reorganize and 
refocus our health care delivery 
system, including building a network 
for primary care as just discussed, but 
it also means a renewed commitment 
to our infrastructure for public health 
programs and services. 

In the minds of many, public health and 
health departments are about providing 
health care to indigent populations, and 
historically, we have been important 
and effective providers of last resort. 
But we cannot afford to have the 
broader functions of public health 
overlooked; we cannot neglect the 
important contributions to the health 
and safety of children and youth of 
such core public health functions as: 
surveillance and control of 
communicable and other diseases; 
protection from environmental hazards; 
health education and disease 
prevention programs; and 
patient-specific disease control 
interventions. 

Many of these activities do not occur in 
a doctor's office or in a clinical setting, 
yet they are unarguably vital to the 
health and well-being of the people of 
my city and of this nation. Disease 
surveillance, for example, serves both 
as a sentinel alerting us to new or 
re-emergent threats, and a research 



tool enabling us to quickly devise interventions that 
stem the spread of disease. To relax surveillance, 
particularly now, as the erosion of geographic barriers 
and complacency about certain practices has made the 
introduction of disease threats more likely, is to let 
down our guard and imperil our people. 

In addition, the formidable epidemiological tools of 
public health can be employed to gain deeper 
understanding of, and devise interventions for areas of 
great concern for our nation's youth, such as violence 
and injury prevention, that traditionally have not been 
considered health issues. 

Public health programs and services are ideally situated 
to reach populations at high-risk for a range of health 
problems. Many of our outreach and community based 
programs offer opportunities for prevention and early 
intervention that are cost-effective and deserve support 
and expansion. 

Through health education and promotion efforts, public 
health also has achieved success in changing 
behavioral patterns involving tobacco and alcohol use, 
diet and exercise. The benefits of such change are 
difficult to calculate precisely, but they are obviously 
immense, whether measured in decreased human 
suffering or economic losses averted. 

Population-based public health prevention programs 
have also had profound influences on social policy and 
have been credited with reducing many health risks. 
With respect to children and youth, activities in the 
arena of enhancing automobile safety and initiating 
other injury control measures are good examples. Such 
efforts have led to significant declines in overall death 
and injury rates in this population. 

Certain environmental issues of great concern to 
children, among them lead poisoning prevention and 
protection of the food and water supply, are the 
responsibility of public health, again enabling us to 
protect health rather than treat disease. Many of these 
functions are critical and unique. What good does it do 
for a child to be screened for lead in a doctor's office 
if there is no mechanism, when a blood lead level is 
elevated, to identify the source of lead exposure and 
have it abated? Better yet, we can work with parents 
and communities to educate them about the possible 
sources of lead exposure to young children and work 
together to reduce or eliminate them. 



Indeed, these public health 
Interventions reflect public health's role 
as "physician to the entire population." 
Not only are public health activities 
essential for attaining our national and 
local health objectives, but, as the 
proverbial "ounce of prevention," they 
collectively represent an extremely 
cost-effective element of national and 
local strategies. 



As the chief health officer of a major city, fraught with 
problems, but also many possibilities, I feel that 
advocacy must be an important role. Along with my 
many colleagues in health leadership positions 
throughout the country, and along with all of you in 
this room, we cannot be discouraged by setbacks in 
national policy around health ... and hard as it is, we 
cannot be discouraged by the fiscal and operational 
problems we face day-in and day-out on our jobs back 
home. 



Any realistic agenda for improving the 
health of children and youth, must 
contain a commitment to public health, 
along with primary care and preventive 
services, better integration and 
coordination of existing health care 
services and improved linkages with 
mental health, substance abuse and 
social services. 

In fact, the elements of a 
broad-ranging, realistic child health 
agenda are not elusive or mysterious. 
A range of commissions and reports 
have elaborated on many of the 
objectives; many have set forth 
recommendations for action. There are 
incremental steps that must be taken, 
and some have been. To a large 
degree, we know what to do, so how 
can we be more effective at getting it 
done? 

First, and perhaps most obvious, those 
in authority, those In leadership 
positions and those with influence must 
make sure that these issues are put 
squarely on our local and national 
agendas. We must convince not just 
politicians, but the body politic itself, 
that the issue of protecting our children 
and promoting their health and 
well-being is a matter of real urgency; 
that perhaps no other investment has 
such serious, long-lasting implications 
as ensuring our children, and truly our 
nation's, future through a commitment 
to improving their health, education and 
welfare. 



And in coping with the serious human problems of 
these children and their families - health problems, 
social problems, economic problems - we must be 
prepared to re-examine old premises and to encourage 
innovation; we need to look at new ways of providing 
services and designing programs. Reports such as 
Starting Points offer us a valuable opportunity to focus 
on new approaches and to explore alternative 
strategies already being tried and working elsewhere. 
Often, when confronted with the many, complex needs 
of urban children, all of us, the public, policymakers 
and providers alike, are tempted to throw up our hands 
in despair. Yet when our composure returns, it is 
encouraging to see that there are programs that, in 
fact, make a difference. 

On many levels, it is extremely helpful to be able to 
look at and learn from programs that work. They can 
guide our own program development across a range of 
areas and help us to more effectively utilize what is an 
increasingly limited dollar. 

Clearly, we need to continue to identify, expand and 
extend such activities for the greater good and health 
of our children. This requires partnership, through 
information sharing, resource development and 
evaluation, and it requires broad collaboration. The 
public and private sectors, and instrumentally 
foundations, must share this vision to make it happen. 

Looking at the complex problems before us, we can all 
agree that real solutions will require us to address and 
integrate the many underlying medical, social and 
economic factors that intersect to influence health. 
Yet this demands an extraordinary degree of 
collaboration, not just within the fields of medicine and 
public health, but also across a range of disciplines and 
among many different kinds of agencies and 
organizations. 



10 



Such collaborations are difficult, and 
worsened by the funding, educational 
and organizational realities of the 
systems In which we work. I am sure 
that all of you have experienced some 
of the frustrations in trying to 
collaborate, even around issues so 
urgent and compelling as the needs of 
children and youth. Categorical 
funding streams, organizational rigidity 
and loyalties, professional education 
and traditions, inadequate resources 
and the fact that so many of us are 
already stretched to the limit so that 
taking on one more thing threatens to 
overwhelm... All of these are reasons 
why well-intentioned and much needed 
collaborations often do not get off the 
ground. 



All of these must be explored, our facilitating effective 
collaboration is essential to any strategy to improve the 
health and well-being of children and families. And in 
this regard, I would be remiss if I did not say a word 
about the vision of Magda Peck in creating the 
CityMatCH organization and initiating conferences such 
as this one. By providing a forum to unite Individuals 
with different backgrounds and experiences, but with 
many similar responsibilities, shared interests and 
concerns, you have offered a powerful opportunity to 
come together around common problems and together 
seek our meaningful, enduring solutions. 

I thank you, Magda, for both your vision and your 
commitment. And, thank you for giving me the 
opportunity to share this program with my father, 
whose vision and commitment, and whose wisdom and 
quiet good humor, has long been a source of both pride 
and inspiration. 



Here again, I believe that foundations 
can play a powerful role. Their efforts, 
reflecting an array of potential 
strategies from convening meetings, to 
assembling blue ribbon panels, to 
producing reports or supporting 
demonstration projects, can help devise 
road maps to navigate some of this 
difficult terrain, can help bring people 
together in new ways and can help 
develop innovative new approaches. 



National, Federal, State and Local Approaches to 
Implementing the Childhood Immunization Initiative 



Monday 

September 19, 1994 



State Leadership in immunization 



Donald Williamson, MD 

State Health Officer 

Alabama State Department of Health 

Montgomery, Alabama 

I am delighted to be with you to share 
a few thoughts on the role of the 
states in providing leadership in the 
immunization effort. First, I need to 
define leadership. Leadership is taking 
risks, it is identifying an issue, a 
position or a policy and getting in front 



and then convincing others you are headed in the right 
direction. Leadership is not figuring out where the herd 
is going and then running to get in front. It may be 
good politics, but it isn't leadership. Leadership can be 
dangerous. Leaders not only catch arrows from the 
enemy in front but also from the friends behind. If a 
leader fails to convince the group he/she is headed in 



11 



the right direction, it gets very lonely 
being all by yourself. But despite the 
risks of taking charge and becoming a 
leader, leadership is something public 
health in general and the states in 
particular have always practiced. I 
would like to begin by focusing on 
some examples of leadership by states 
in the immunization effort. 

Many states made the decision to 
purchase vaccines for all their children 
before the current and most recent 
interest in immunizations. States such 
as North Carolina and Rhode Island are 
two such examples. But even in an 
area as apparently noncontroversial as 
providing vaccines for children, there 
are still pitfalls. South Carolina made 
an effort several years ago to become 
a universal purchase state; however, 
despite good preparation and planning, 
other factors beyond their control 
intervened to prevent universal 
purchase. 

States across America have undertaken 
specific actions to improve 
immunization levels. The Childhood 
Immunization Initiative (Cll) and the 
development of Immunization Action 
Plans (lAPs) have served as catalyst for 
many of these efforts. 

Many of us have worked to develop 
community involvement in our 
immunization activities. We have come 
to understand that simply providing 
vaccine and giving shots will not get all 
children immunized and will not 
eliminate vaccine preventable disease. 
Communities must be involved in this 
process. Immunizations must become 
something parents value and expect. 
While we in public health struggle to 
involve partners in the immunization 
effort, we must always remember that 
while we can share resources and 
opportunities, we cannot share ultimate 
responsibility. For ultimately it is the 
public health system that is responsible 
for preventing the occurrence and 



spread of vaccine-preventable diseases. Thus, an area 
of state leadership must be to clearly define the roles 
and the responsibilities of our partners in these 
initiatives so that no false expectations are created. 

While all of us over the past years have worked to 
develop community support, other more specific 
actions have also been undertaken. Texas has recently 
earmarked millions of new dollars to ensure the 
immunization of its children. It has launched an 
ambitious campaign called "Shots Across Texas" with 
publicity and fanfare. This is another example of when 
leadership sometimes causes problems. At the time 
Texas and other states developed these initiatives with 
their own local populations in mind, a federal initiative 
was also launched. While this initiative was designed 
to enhance and strengthen local efforts, many of us in 
states were concerned that the federal effort would 
only confuse citizens with two slogans and two 800 
numbers. Others, including Alabama, have developed 
incentive campaigns with T-shirts, McDonald's 
coupons, and other incentives for receiving or 
completing timely immunizations. 

With the additional funding from lAP, states have been 
able to not only develop coalitions, expand outreach 
and education but perhaps most importantly, increase 
access to immunization services. States have taken 
vaccine efforts into housing projects, after-hour clinics, 
Saturday clinics and shopping malls. In Birmingham, 
Alabama, the local health department set up 
immunization services at an amusement park. Not only 
has building community support been helpful in 
changing community and parental expectations, it has 
also (at least in my state) provided a new source for 
vaccination. The local National Guard decided that 
helping immunize children in rural Alabama was at least 
as good a training experience as giving shots in Central 
America. While working with this new partner has had 
an occasional rough spot, it has been well worth it 
because of the additional services made available for 
Alabama's children. 

The Childhood Immunization Initiative and the 
development of lAPs have served to spearhead the 
development of greater community involvement, 
increased outreach and education, provided incentives 
for immunizations, and funded expanded clinic hours 
and sites. Perhaps the most important effect of the 
renewed emphasis on immunization has been not so 
much to change the general community as to change 
us, the public health community. 



12 



The outbreaks of measles in the late 
1980s and early 1990s were not in 
large measure due to a new super bug. 
True, some of the measles on college 
campuses was due to primary or 
maybe secondary vaccine failure; but 
for the most part, measles was 
occurring in unimmunized preschool 
children. Was it a surprise to health 
departments that these children were 
unimmunized? No! Was it a surprise 
that children unvaccinated exposed to 
measles get sick? No! So what is the 
explanation? We (especially those of 
us born after the polio epidemics) had 
just gotten complacent. We had other 
problems-AIDS, infant mortality and 
others. We couldn't be bothered just 
because a parent didn't get a child 
his/her shot, would we accept the 
same excuse about a TB patient who 
didn't come in? Of course not! Many 
of us at the state level were shocked 
out of our cocoon of denial by the 
measles epidemic. 

Many of our initiatives don't require 
dollars, they just require will, work and 
effort-dollars are easier. In Alabama 
we quickly identified obvious areas 
where we were simply failing to 
maximize immunization efforts-like 
failing to screen WIC children for 
immunization needs, failing to give 
simultaneous vaccinations and missing 
opportunities due to false 
contraindications. Without new dollars 
but with a new commitment beginning 
about four years ago, we have been 
able to increase our two-year-old levels 
from 58 percent age appropriately 
immunized in 1988 to 76 percent in 
1994. And, the level in the public 
sector is now higher than the private 
sector. These changes came about 
before lAP or Cll. It just took 
commitment. 

Now let me turn to a final issue in 
closing-the VFC. VFC has not been a 
program that has had universal support 
from the states. Many of us are very 



concerned about the complexities and potential 
confusion which this program may cause. Most of the 
states would have preferred a universal purchase 
program so that we could have used state dollars not 
for vaccine purchase, but rather for infrastructure 
support. Nevertheless, this is the program we have 
and we will make it work. 

There are certainly parts of the VFC that states 
strongly support. We are excited about the prospect of 
immunization as an entitlement for children. States 
who often use up to 40-50 percent state dollars to 
purchase vaccine for children strongly support the right 
of states for unlimited optional purchase from the 
federal contract at reduced prices. This is essential so 
that states who wish can exercise the option of 
purchasing vaccine for all their citizens, irrespective of 
income. We have been pleased about the willingness 
of CDC to work with states to minimize paperwork in 
both the public and private sector. We feel that 
keeping paperwork to an absolute minimum is essential 
if we are to have significant private provider 
participation. Many health department clinics are today 
filled with children referred from private providers for 
immunizations. This is less than desirable care for the 
child since it promotes discontinuity of health care and 
disrupts the medical home. It is also problematic for 
public clinics by filling space with patients who could 
be served elsewhere. 

While we applaud these positive elements of the VFC, 
there are areas with which states take exception. 
While the paperwork has been kept to minimum, the 
requirement that some effort be made to determine if 
a child has insurance, if that insurance covers 
immunizations coupled with the fear that someday an 
auditor may want to review these determinations, 
concerns states and will, if not carefully implemented, 
do serious harm to this program. 

States are especially concerned about the requirement 
that "underinsured" children can only receive VFC 
vaccines at Community Health Centers. First, what is 
an underinsured child? Isn't that a lot like being "a 
little pregnant?" The truth is a child is either insured 
for immunizations or they are not; thus they may be 
uninsured for immunization, they are not underinsured. 
The idea of a public health agency identifying a child as 
being in need of immunizations and then having to refer 
them across town to a Community Health Center to get 
that vaccination because they are "underinsured" is 
abhorrent. That means we are to hope, pray and 



13 



assume that they will go and keep the 
appointment. Never mind that they 
may have paid $5-$10 for a friend to 
bring them to the clinic in the first 
place. This is the sort of complacency 
which allowed measles outbreaks In the 
first place. No better reason can be 
found for the necessity of state 
optional purchase than that scenario. 
States must be able to purchase 
vaccine at low prices (from the federal 
contract) to immunize these children in 
public clinics and to give vaccine to 
private providers for use in their clinics. 
This is right for the children and It is 
correct public policy. 

With October 1 closing in and the start 
of the VFC imminent. It has been with 
growing distress that we have watched 
efforts being made to change this 
program. First, a national warehouse 
which was to be used for distribution 
was canceled by the administration 
after a GAO report. Unfortunately this 
left approximately half of the states 
unsure about how to get vaccine to 
providers, especially in the private 
sector. But despite this unexpected 
problem, some states have decided to 
develop their own distribution systems 
for the private sector all In a matter of 
days. Despite uncertainties about how 
vaccine will be distributed, we continue 
to recruit providers because somehow 
we will make It work; we have no 
choice. 



profit margin to support research and development. 
We have no desire for the VFC program to destroy the 
private vaccine market. However, we cannot and will 
not support some of these proposed changes. We will 
not support changes that so increase paperwork and 
bureaucracy in the name of accountability that private 
providers won't participate. We must increase vaccine 
delivery in the private sector. 

Second, states cannot see their ability to purchase 
vaccine at reduced federal prices so restricted that we 
are unable to buy non-VFC vaccine for use in our 
clinics or to distribute to private providers for the 
"underlnsured." Failure to protect this right could, in 
fact, further fragment health care for children and 
reverse the progress we've made on immunizations. 
Certainly the best solution to the problem of the 
underlnsured Is legislation guaranteeing to all first dollar 
coverage for Immunization. That would eliminate this 
group entirely. 

I would like to close by again noting that leadership Is 
not without risks. Whether it Is at the state level, 
federal level, or local level, getting In front sometimes 
makes one a target. But when the cause is the health 
of America's children, I can think of no better reason to 
be a target. Reaching a goal of 90 percent of the 
children appropriately Immunized by the Year 2000 
will not occur because of the states, the federal 
government, local health departments, parents or 
communities. This goal can only be reached by 
working together In a true partnership. The Year 2000 
is only 6 years away, we must get on with this work. 
Let's go lead. Thank you. 



Now after surviving that crisis, talk in 
Congress is of technical corrections to 
VFC. Considering the Impact of some 
of these proposed changes, calling 
them technical corrections is like calling 
the sinking of the Titanic a "boating 
mishap." The proposed changes 
would, among other things, increase 
accountability and reduce the ability of 
the states to purchase vaccine from the 
federal contract. Let me assure you 
that the state health officers are very 
supportive of the vaccine industry and 
we recognize the need for a reasonable 



14 



Violence and Public Health: 
Problems to Policies 



Tuesday 

September 20, 1994 



The Honorable Ellen Anderson 

Minnesota State Senator 
St. Paul, Minnesota 

This talk is about using data and 
research infornnation to create good 
public policy. While data and statistics 
are often used to put audiences to 
sleep and to disguise the ennotional 
content of factual situations, statistical 
data can also be used to grab one's 
attention in a powerful way. One of 
the nnost compelling examples I heard 
recently came from a school 
administrator talking about the fact that 
we don't value our children very much 
in the United States. He said that in 
this country it is more likely that our 
dogs are inoculated than our children , 
and that we spend more on cat food in 
this country than on school textbooks . 

As a first-term state legislator, I can tell 
you from personal experience that I 
don't believe we make nearly enough 
use of cold, hard data and research in 
making our public policy decisions. 
You have all heard the old line about 
how it's equally unpleasant to watch 
laws being made as sausage . Believe 
me, I can vouch for the fact that a 
great deal of our law-making is about 
as based on rationality and factual data 
as are the horoscopes in the morning 
paper (I apologize to anyone in the 
audience who is a fervent astrologist). 

Unfortunately, the issue of crime and 
violence, and what to do about them, 
is one of the worst culprits for 
policy-making based on fears and 
demagoguery. Although the Minnesota 
Legislature has a well-deserved 
reputation for some of the most 
innovative, progressive policy-making in 
the country, we are subject to the 
same political pressures to increase 
penalties and build more prisons. 



without any rational basis for believing this will make 
our people safer in the short or long run. However, 
after my two years in the Senate, my sincere hope is 
that we can step back from the usual path, closely 
examine all the data and research that exists, and put 
it to work crafting crime prevention policies that truly 
have a hope of reducing crime and violence for future 
generations of Minnesotans. 

Minnesota Efforts 

I would like to tell you about one of the ways we are 
trying to achieve these goals in Minnesota. During my 
first session, in 1 993, I had some discussions with a 
lobbyist for United Way about the origin of a statistic 
we had both heard used repeatedly: that something 
like 90% of men in prison were born to teenage 
mothers. We did a little investigating and found that 
nobody seemed to know where it came from or who 
said it first. I had saved a newsletter from some local 
organization that cited the statistic, but when I called 
them they couldn't track down its source either. We 
started talking about the need for some real data, 
Minnesota data, that could help us determine who is in 
prison and why those particular people end up in 
prison. I was successful at getting the Legislature to 
pass my Inmate Survey bill with a totally inadequate 
appropriation of $25,000. Luckily, some local crime 
prevention organizations - the Citizens Council and 
United Way ~ as well as a respected University of 
Minnesota social scientist. Dr. Jane Gilgun, got excited 
about the project and ended up doing a very 
comprehensive survey of 1700 inmates, about 100 
women and 1 600 men, out of a total prison population 
of about 4000, from all Minnesota prisons. They used 
the concept of risk factors and protective factors 
during childhood to organize the results, and compared 
the inmates on key risk and protections with three 
other control groups, including large groups of 
non-inmate adolescents and adults. The researchers 
believe it to be the first study in Minnesota and 
possibly the nation to identify both risk and protective 
factors in the lives of prison inmates. (The study A 
Survey of Minnesota Prison Inmates: Risk and 



15 



Protective Factors in Adolescence, has 
been released and is available by 
contacting the Minnesota Citizens 
Council on Crinne & Justice, 822 South 
Third Street, Minneapolis MN 55415, 
612/340-5432.) 



the risks appeared to "pile up," making them more 
likely to have negative behaviors or outcomes. 

Having Learned Some New Things About Prison 
Inmates, the Question is How We Can Use this Data to 
Build Good Public Policy? 



Let me first back up and explain some 
of the research this study was 
patterned after. Dr. Peter Benson of 
the Search Institute in Minneapolis has 
identified a list of "assets" and 
"deficits" that correlate with emotional 
well-being or with high-risk behavior, 
depending on which a young person 
has more of. The inmate survey 
reflects other research based on some 
similar concepts, that indicates a 
correlation between high risk factors, 
low protective factors, and the 
likelihood of being involved in criminal 
activity. Examples of important 
protective factors are close 
relationships with positive role models, 
opportunities for education and jobs, 
etc. 

The most significant finding of the 
inmate study was that the one factor 
that most distinguished inmates from 
non-inmates was the likelihood that 
thev had someone in their life thev 
discussed their problems with . The 
most important risk factors, which 
inmates were much more likely to have 
than comparable non-inmate 
populations were physical and sexual 
abuse, poverty, and low parental 
education. Out-of-home placements 
were very high among inmates during 
childhood and adolescence. But 
contrary to popular belief, most 
inmates were not born to unmarried 
teenage parents. 

Inmates also had protective factors in 
their childhoods and adolescence. For 
example, most inmates felt care for by 
their parents and did not differ 
significantly from non-inmates in this 
regard. Yet, inmates experienced risks 
which overwhelmed protections and 



I have three suggestions which I will discuss one at a 
time. First, as we present data to the public and to the 
legislature, we have to answer two basic questions to 
persuade them it's important and relevant data, 
especially because statistics are so often misused: 

A. We have to be able to state convincingly that 
changing the characteristics of people as 
recommended by the data will, according to 
statistical probability, in fact reduce future 
violence. 

B. We must be able to state convincingly that law or 
policy can accomplish the recommended changes 
in individuals. 

To better explain what I mean, I'll refer back to the 
Inmate Survey. I had two questions for the researchers 
that we would need to answer for legislators. First, is 
it valid to say that if we reduce the risk factors and 
increase the protective factors in any given population, 
would we be accurate to predict that criminal behavior 
will be reduced in that population? In other words, is 
there a cause and effect relationship? Based on the 
data, can we say that we know how to reduce crime 
and violence? 

The second questions for the researchers is, is it 
possible to affect the risk and protective factors in 
populations by changing public policy? Well, the social 
scientists were very cautious about answering the first 
question, and would only go so far as to say that there 
is a statistical correlation between these factors and 
being an inmate, so the population should be 
statistically less likely to be inmates if we increase their 
positive factors and reduce their negative ones. That's 
good enough for me, and I think it should be good 
enough for legislators and the public. 

As to the second question, is it possible for us to affect 
a child's risk and protective factors? I believe it is, but 
I think this is an area in which we are lacking good 
data. There has been a push in recent years by "good 
government" types to improve our evaluation of our 
government-sponsored programs. In Minnesota we 



16 



have instituted various reforms which 
have the purpose of compiling 
information to evaluate outcomes . But, 
I don't think we have enough 
comprehensive information about 
which types of intervention in 
children's lives increases their 
protective factors or decreases their 
risk factors. 

But some of this just takes common 
sense. Obviously, policy makers 
cannot pass a law mandating that 
every child has someone they trust to 
talk to about their problems, but we 
can fund and promote big brother/big 
sister programs and adult/youth mentor 
programs, and we can mandate better 
training for school counselors and 
teachers and others who routinely deal 
with children how to recognize whether 
a child needs someone to talk to and 
how to teach boys it's all right to talk 
about their feelings. These are such 
simple, humane, and affordable steps 
that it seems it should be an easy 
matter to get legislative support for 
them. 

The second part of an effective 
strategy for changing public policy is 
that we have to shatter myths that are 
used to justify our existing policies. 
Here's an example. Most of the public 
fear about crime is associated with 
random acts of violence perpetrated on 
people on the street or in break-ins into 
their homes. Senior citizens feel afraid 
to walk their neighborhood streets. But 
look what we learned in Minneapolis in 
their recent Kidstat Public Health 
report: The most shocking statistic in 
there is that the highest homicide rate 
in the city is for infants under the age 
of one. 

This should point our policy-making in 
a different direction, both for political 
reasons and for fact based reasons. If 
the public understands the threat is 
greatest to the most vulnerable tiny 
citizens in their own homes from their 



own families, that gives politicians more freedom to 
devote more time, resources, and rhetoric to the 
problem. The information leads us to different 
conclusions about how public policy should be 
formulated to reduce homicides: perhaps instead of 
more police on the streets, we need more social 
workers and public health nurses making in-home 
visits. Instead of targeting gang members, we need to 
target families that are stressed and provide respite 
care for their children while the parents take a break. 

The third part of the strategy is to build public support. 
This requires the media to stop exploiting the crime 
problem and the public to stop demanding candidates 
to be tougher and tougher on crime. I think the key is 
more education and public awareness. Last session I 
authored a bill to create a Violence Prevention Task 
Force, which is mandated to define violence 
prevention, set violence prevention goals for the state, 
and advise the legislature how to make violence 
prevention policies part of its work. We plan to survey 
all of the research out there, survey all of the violence 
prevention efforts currently going on, and report on 
where all of our state crime dollars go. 

I believe a key to success is getting as much media 
coverage as possible, and building public understanding 
and support early in the legislative session, so 
lawmakers will take notice. We have assembled a 
dynamite group of people, including one high-profile TV 
anchorwoman, and others who we hope will draw 
attention to what we are doing. 

Another Part of Building a Community Consensus 
Requires Us to Listen to the Experience of 
Communities. 

The violence prevention task force is collecting 
information from all over the state, from local groups 
working on violence prevention in schools and 
communities. Research and laboratory tests of social 
science theories are important but the real test of their 
validity comes with practical application. Only with 
experience can you answer questions, such as how can 
a community go about building resiliency or protective 
factors in children? What really works? What kind of 
intervention are families really willing to accept in their 
homes? 

This is important not just for testing the theories but 
also for political reasons. Grassroots support for 
changing public policy is one of the strongest assets a 



17 



legislator can have. Other legislators 
will listen carefully to active community 
members who happen to also be voters 
from their legislative districts. 

What are the Chances of Succeeding? 

As I hinted at the beginning of my talk, 
I am rather cynical about the frequency 
with which law-making is based on 
rational facts and data. In Minnesota I 
think we could easily go in either 
direction. Right now we are in the 
middle of a Governor's race. The 
liberal Democratic candidate is 
proposing a tax increase on the 
wealthiest 4% of Minnesotans to pay 
for children's programs like Head Start 
and child care. He argues that if we 
don't pay now, we will spend far more 
later. The newspapers and his 
opponent are gleefully exploiting his 
honesty about proposing a tax increase 
and the public may not be convinced to 
elect the governor with the "investment 
strategy." Here in Washington, you 
witnessed firsthand the rhetoric 
surrounding the crime bill which 
reduced its efforts at preventing crime 
to "pork." I hope we can have a more 
rational debate in Minnesota. 

There are some factors working in our 
favor. We certainly have a number of 
legislators who fight hard for 
prevention policies every session. Two 
years ago, some of them were 
successful at getting the Legislature to 
commit to putting a dollar into 
prevention for every dollar into prisons 
or punishment. During the 1994 
session, this commitment fell by the 
wayside as it did ail across the country, 
and Minnesota invested in its biggest 
prison expansion in history. 

Based on another major legislative 
battle we had last session, over the 
storage of nuclear waste and our 
state's future energy policy, I also have 
faith in what could be called a "New 
generation" of legislators: many 



newer, often younger, often women legislators who are 
willing to take tough votes against politically popular 
ideas that really don't serve the public well in the long 
run. 

We are going ahead with our plans to present the 
Violence Prevention Task Force report and the Inmate 
Survey report to the legislature, and we hope the media 
will pay attention. If we can get some of the numerous 
community groups working on prevention efforts to 
rally around our proposals, that will significantly 
increase our chance of success. 

Conclusion 

Even if we are able to win change in public policy 
based on new data, I fear that it will be accomplished 
piecemeal. In my view, good policy changes like the 
ones I have suggested will not accomplish the 
predicted result unless they are universal and long- 
term . The types of recommendations I've discussed 
also leave out some of the most important factors that 
relate to the stability of families and their children: 
housing, poverty, availability of jobs, etc. 

My dream would be for Minnesota's Violence 
Prevention Task Force to be able to issue a 
comprehensive report that plans for a whole 
generation. I would like to be able to present a 10-year 
plan or 20-year plan to the Legislature and tell them 
authoritatively: if you pass these policies and fund 
them fully, we will have 50% less violence and 50% 
fewer violent crimes in the State of Minnesota 20 years 
from now - and here's the proof. For example, if we 
want to serve X number of children, we need to spend 
X dollars on providing positive adult mentors for each 
one, at a total cost of X. Multiply this by every other 
necessary program and the result in that population will 
be X amount less likelihood of violence. 

This kind of a comprehensive formula is hard to come 
by and if it does exist, its validity may be subject to 
question by even the most ardent statisticians and 
social scientists (not to mention politicians). Of course 
the cost of such a proposal would be high, but I think 
our research can show conclusively that over the next 
20 years it would be a money-saving policy for our 
state. 

I personally believe this would be the most persuasive 
type of argument to help change our present course 
and the most persuasive type of data to support such 



18 



a change. I would like to ask all of you 
a question. How far do you believe we 
can go in predicting and changing 
human behavior by social engineering 
or by public policies? Do you believe if 
we apply the right mathematical 
formula and the right research and data 
to our public-policy-making that we can 
change the course of human events? 



I will close by saying that however you or I would 
answer that question, as a person and as a politician I 
must make it clear that I believe our obligation is to use 
whatever humane means we have at our disposal to 
reduce crime, violence, and all of the human suffering 
that results. 



Local Public Health Leadership 
in Times of Transition 



Wednesday 

September 21, 1994 



Meredith Tipton, PhD, MPH 

Director, City of Portland Public Health Division 
Portland, Maine 

How long does it take a vision to 
become a reality? Well, many factors 
will determine the answer on a case by 
case basis. Fifty years ago, in 1944, 
the then surgeon general Thomas 
Parron, signed the Public Health Service 
Act into law. This law foresaw the 
need to develop an integrated system, 
which insured personal care and well 
financed public health programs, that 
compliment and support each other. 
Fifty years later, the public health 
community will most probably see Dr. 
Parron's vision realized. 

What's in it for local public health? 

Government became engaged in public 
health, because there was a public 
concern for the general welfare, safety, 
and health of the people. There is a 
unique role for government public 
health practice at the local, state and 
federal level. Their responsibilities are 
different, from other public health 
agencies because they are 
governmental entities . You have a 
document in your folders entitled 
"Blueprint for a Healthy Community, A 
Guide for Local Health Departments." 
I would encourage all of you to read 
this document at some point. It's not 



meant to be a cookbook, but merely a springboard. In 
the "Blueprint" there is this quote, "We must be certain 
that the unique responsibilities of government are well 
expressed, and operationalized in the current 
environment and structure. As foreboding as the 
uncertainty, of how the future legislation, as it will 
craft healthcare reform, at the national and state levels 
and how that impact on us," there are other critical 
factors in the environment, that will have equal or 
greater impact: 

1 . The continuing dissatisfaction of the taxpayer with 
the perceived status quo of government, at all 
levels, looms over all of us. We are challenged to 
make revolutionary changes, in the way we do 
business as government entities . In the national 
best seller Reinventing Government , by David 
Osborne and Ted Gabeler, there are many good 
ideas that can offer new boundaries and new 
approaches, while giving you permission to make 
the changes organizationally, that are necessary to 
fulfill the core functions. 

2. The changing role of hospitals in addressing 
community health needs , is another uncertainty in 
all cities. Do you know how your hospitals would 
define who in your community has responsibility 
for: 1) Community health leadership? 2) 
Collection, analysis, dissemination and, the 
repository of data on your community's health 
status? 3) Prevention activities? 



19 



Hospitals have not traditionally looked 
beyond their own system as a place to 
provide health services. Now as 
networks are developing, 
integrated/managed care takes hold 
and the community benefit requirement 
looms larger than ever for all hospitals, 
they are beginning to look beyond their 
traditional boundaries. We need to be 
able to answer the question posed In 
the introduction to NACHO's Blueprint, 
and I quote, "What does it take to 
create and maintain a healthy 
community?" 

The Healthcare Forum, a think tank 
organization for healthcare providers 
with a diverse membership, has just 
published an executive summary of a 
national survey they sponsored. The 
purpose of this survey was to identify 
a framework that will help define " the 
way we achieve health " in this country. 
This framework will be designed using 
new strategies that will lead toward the 
creation of health in our communities, 
rather than strategies that merely 
improve the way we treat illness. They 
go on to state in the Healthcare Forum 
report that the solutions to many of the 
leading causes of illness and premature 
death do not rest within our hospitals 
or medical delivery systems, as 
currently configured. Many of these 
solutions rest with socio-economic 
factors, our behavioral choices, and 
those practices we encourage (or 
condone) as family members, neighbors 
and fellow citizens in the community. 

Sound familiar? Health care reform, 
taxpayer unrest, sharing the community 
are all good reasons. In fact, THEY 
ARE THE REASONS TO UNDERSTAND 
AND DEVELOP CAPACITY TO CARRY 
OUT THE CORE PUBLIC HEALTH 
FUNCTIONS IN YOUR HEALTH 
DEPARTMENT. The Academy of 
Sciences, in findings from four of their 
major sponsored reports, 
unquestionably state a stronger more 
responsive public health system will be 



necessary in order for healthcare reforms to succeed. 
What will it take? 

1 . Strengthening public health leadership. 

2. Enhancing professional competence among public 
health leaders and staff. 

3. Revising outdated local ordinances and state 
statutes. 

4. Filling gaps in data collection. 

5. Improving the systems analytic capacity to use 
data efficiently. 

6. Ongoing links between public health, and private 
sector healthcare for population wide responsibility 
of public health. 

We are all challenged to shift our thinking away from 
the delivery of personal services towards population 
based services . As an example, we all know as public 
health experts, the causes of premature death are 
attributed to the following: 10% come from lack of 
access, 20% from inherited or genetic factors, 50% 
from behavioral consequences, and 20% from 
environmental. A quick look at this data shows that 
70% of the causes of premature death, need to be 
addressed through population based approaches. 
These interventions need to address the causal factors 
influencing a population of behavioral and 
environmental outcomes. With that as a means of 
introduction, let me briefly run through some examples 
of population based services and then talk to you about 
what the core functions are. You should be familiar 
with these examples of population based services. The 
State of Washington has defined them well. 

• Health surveillance programs such things as vital 
statistics, communicable disease reporting, chronic 
disease registry. Other examples of population 
bases services: health protection programs; 
drinking water monitoring; food sanitation; toxic 
chemical regulations; occupational safety; 
childhood lead poisoning programs; personal 
preventive programs, which include immunizations 
and communicable disease investigation. 

• Health promotion programs which include such 
activities as alcohol and drug education, tobacco 
control, injury and violence prevention. There are 
other categories of services which one may 
question as to whether or not they are population 
based, but they need to be included as part of the 
assurance function. These services include 
information and referral; public health nursing home 



20 



visits; case management; 
facilitating resource development; 
medicaid outreach and the like. 

All of you are familiar with the three 
description words: Assessment, Policy 
Development and Assurance. I find it 
helpful to see this as NACHO pictures 
it - a process cycle. You have a 
definition sheet in your packet that was 
taken from a document prepared by 
NACHO in July 1993. It represents 
some of the beginning work from 
NACHO in describing the core public 
health functions for local health 
departments. 

We all come from different sizes of 
local health departments. However, 
there are key roles that local health 
departments play in partnership with 
state health departments. I would like 
to clarify what NACHO considers key 
roles for the local health department. 
The local health department is 
responsible for serving as the collectors 
of local data. Not only on their own 
services but others occurring within the 
community. The state health 

department helps in assembling the 
overall picture, developing reference 
points and trends. In addition to the 
secondary data, the local health 
department assesses the citizens' 
perception of community health status 
- of what people believe to be the most 
important health issues facing their 
community. 

Another function of the local health 
department in the assessment process 
would be to manage the health 
resource inventory, to convene public 
meetings and public forums, to conduct 
polls, to collect information from the 
private and non profit providers, and 
engage in research. A third function, in 
partnership with the state health 
department, would be to provide local 
interpretation and forecast of health 
data and other related information and 



serve as a repository of this information for the 
jurisdiction served. 

I cannot stress this element enough. 
In my state, the city that I have jurisdiction for is the 
largest city in the state. It is the headquarters for 
statewide media services. We are constantly the first 
contact for the media on any kind of health data that 
is submitted to the press, whether it is related to our 
community or not. So, it is critical that you develop a 
communication protocol with your state health 
department. 

Another key function for the local health department, 
and I believe the function that no one else can play in 
your community, is the responsibility to provide, the 
leadership at the local level in disseminating information 
to the public on the community's health status. It is 
our responsibility to provide information directly to the 
news media, community officials, and elected officials, 
and to publish easily understood reports. 

It is our responsibility, after all, to be the unaffiliated 
organization in the community that can speak 
objectively to what this data means and how it will 
play out in our community as it relates to public health. 
It is not our responsibility to have another agenda when 
we assume that role. Although tempting, we have to 
be very careful not to blend our role as leaders and our 
role as advocates. 

The second core function of the local health 
department is informing public policy. What that 
means is: depending on the political environment, 
some of you may or may not have ultimate 
responsibility for policy development. In my 
jurisdiction, my elected officials are my Board of 
Health, and although 1 may research and write, and 
shepherd the policy, it will still be their policy. We 
have to be very clear about where our roles stop, and 
where they don't. The process of policy development 
relies on scientific information, and your data from a 
variety of assessment procedures. You put balance on 
that information. You make sure that you hear from all 
parties that are interested in the issue. You develop 
concepts of political, and organizational feasibility, so 
that decision makers have a broader scope as to the 
potential impact. You take into account your 
community's values, and through an open process you 
involve all, in the private and public sectors, in policy 
development through communicating with them. 



21 



through networking and 
building constituencies. 



through 



Again, let me try and clarify the 
difference between what happens at 
the local level; vis-a-vie the state level. 
As most of your know, many health 
policy issues first develop at the local 
level. Regional or state policy 
development efforts ought to occur 
only when local leaders agree that 
centralized policy development is more 
efficient and effective and then only 
with the active participation with 
communities. This approach is based 
on the assumption that the strongest 
public health policy is developed and 
owned by citizens at the local level. 
Local health department should provide 
a leadership role in developing local 
priorities, plans and partnerships that 
encompass the entire community. The 
local health department should also 
have the authority to initiate, develop 
and draft local ordinances or rules on 
health related issues requiring a specific 
local response. And again, you know 
how your policy development process 
works within your own governmental 
entity. Whether you write it, or 
whether you rely on your city attorneys 
to write it, you have to be involved 
because YOU come with the expertise, 
and can really put the substance into 
the document that will evolve into the 
public policy statement. 

The third public health core function is 
the one that we know all so well, and 
do all so well. That is the Assurance 
Function. That's where we're making 
sure that health services are available. 
We also assure that population based 
services, whether they be personal 
preventive services, improved access to 
care, or health promotion and 
education programs are available. 
That's a critical assurance activity, it 
does not say we must provide it. It 
says that we should encourage it, we 
purchase it from others, or we provide 
it. 



The last assurance activity includes maintaining 
administrative capacity within our own organizations. 
This would be measured by evidence of: 
1 ) A strong personnel human resources capacity, 2) A 
very strong contracting capacity because as we move 
away from delivering direct services we need to have 
the capacity to be sure that others can do them, 3) A 
strong financial capacity, which includes a creative 
financing budget, management and ability to leverage 
dollars, and 4) Good legal counsel. 

Again, to articulate the role of the local health 
department, your assurance function can be played out 
by your capacity to advocate, to serve as catalysts, 
and coordinate organized responses to priority needs in 
your community. In cases where no other resources 
are available in the community, local health 
departments need the capacity to either purchase or to 
provide directly those personal health care services 
identified as priorities. Lastly, local health 

departments, and/or other community organizations, 
need the capacity to provide population-based health 
promotion, health protection and preventive health 
services within the community. 

Why should local health departments perform these 
functions ? 

I would challenge you all to look at your organization's 
mission. Why is it that you have the mission that you 
have, compared to the mission that other organizations, 
that may seem to have similar services packages have? 
How are their missions different from yours? I would 
say that no other organization in your community has 
the mission that carries the same responsibility, which 
is, improving the health status of the population versus 
the treatment of individuals. It is impossible to provide 
population based services without engaging in the three 
core functions. 

The reason that you get involved in performing the core 
functions is to provide you the capacity to have the 
foundation for population based services. It's also your 
key to your role in prevention. No other agency 
primarily addresses the true causes of morbidity and 
mortality through preventive services as local health 
departments do. You have a role in anticipation . Local 
health departments anticipate and prevent disease and 
injury. They anticipate in a pro-active manner so that 
they can mobilize efforts to promote health. 



22 



How would the role of your local health 
department change, with the upcoming 
healthcare reform, and the subsequent 
out-fall from It? I would suggest that 
there are many things that you will be 
doing differently, some things you will 
stop doing, but many things will require 
a strengthening of your skills to do 
better, more, and step forward and 
take leadership in. The first thing that 
you need to do is do not give Into the 
urge to fill the market gap as we have 
in the last 80 to 120 years. 



You will be moving away from the delivery of personal 
health services. If you are not moving away from 
personal health services, the balance between personal 
health services/assurance and the policy development 
and the assessment functions will change. There will 
be greater emphasis on the latter two. Your next 
challenge is to break the mental models. If any of you 
are fans of Peter Senge and his book. The Fifth 
Discipline , you are familiar with this term. It's getting 
rid of, the same as, "we've always done it this way," 
the sacred cows, the logs in the middle of the stream. 
That kind of thinking, the illusions or perceptions, are 
what keep people stuck. 



....We have looked at our community. 
....We have assessed the need. 
....We see a need and we go fill it. 

No longer is that an automatic role 
according to the three core functions. 
Remember, under the assurance phase 
you were encouraged to purchase and 
then finally, to provide services. Your 
second role is in the development of 
new partners. Partners that you have 
not come to the table with before - you 
have not even thought of inviting over 
to your office before. Many of these 
people are your previous competitors. 

Your third role would be as a 
community leader. This role will take 
many forms. You will become a 
convener, you will become a catalyst, 
you will become a facilitator, a 
collaborator and a partner. Most 
importantly, you will become a role 
model. You will teach people how to 
do all these things. You will 
demonstrate and inform the community 
on approaches that lead to new 
problem solving, community ownership, 
and community resource generation. 
There are a variety of ways that we do 
that. Our agencies are at different 
stages of development as we move 
into this. All of us have skill building to 
do. 

How will the roles of health 
departments change in the future ? 



In the work by David Osborne and Ted Gabbler, 
Reinventing Government , I have found that there are 
some philosophical descriptions in that document that 
clearly support moving public health away from 
personal health services and into the three core 
functions. These authors frequently use the terms. 
Steering and rowing activities. In their first chapter 
called "Catalytic Government" they quote a definition 
by E.S. Savas. He defines government and I quote, 
"the word government is from a greek word, which 
means to steer. The job of government is to steer, not 
to row the boat. Delivering services is rowing and 
government is not always very good at rowing." 
Further into that chapter, the authors talk about 
governments changing their roles, saying that "city 
government will have to make adjustments, and in 
some ways redefine their traditional roles. I believe the 
city, in the future will more often define it's role as a 
catalyst and a facilitator. The city will more often find 
itself in the role of defining problems and then 
assembling resources with others, to be used in solving 
those problems." 

City government will have to become more willing to 
interweave scarce public and private resources, in order 
to achieve it's communities goals. If you think about 
the core functions they clearly are steering. They are 
leadership, they are facilitating, they are moving people 
forward, they are leveraging resources. Rowing is 
what we have done and we have done well. But if we 
continue to row we are not fulfilling the challenge of 
the core functions. 

In 1991, Hillsborough County, Florida, Public Health 
Unit Florida analyzed what they were doing around the 
three core functions, and I dare say that they probably 
look very comparable to what the rest of us would look 
like at that same point in time, if we assess where we 



23 



are placing our resources in addressing 
these core functions. On a scale of 1 
to 1 00, the percent of manpower hours 
Hillsborough County put into 
assessnnent was 9.1%. Policy 

development was 2.1 % and assurance 
was 88.7%. They were definitely 
rowing . We all struggle to address the 
needs of our customers. We are many 
times bound by the barriers that are put 
up by our funders, or the limitations 
that we have put on ourselves, in 
designing our programs. 

We must move from categorical 
program-driven service activities to 
customer driven de-categorized 
funding. Another action that health 
departments are going to have to take 
is to reorganize. To put the three core 
functions into many existing 
organizational charts makes absolutely 
no sense. If you are going to organize 
to carry out these core functions, the 
required skills may not now be placed 
appropriately. You will most likely 
need to retrain staff to carry out the 
core functions. 

The other thing that you are going to 
have to do in terms of breaking the 
mental models is you really need to 
reinvent yourself. You are going to 
have to start thinking of ways in your 
bureaucracy, the system you work in, 
to strive towards removing many of the 
unnecessary controls. We get caught 
up in trying to please the unnecessary 
controls, and we waste a lot of our 
resources, whether they be in steering 
or rowing functions. You need to 
promote competition within your 
organization. Staff have tended to not 
assume responsibilities for some of the 
things that are critical to making 
government run smoother. There are 
many ways that you can promote 
competition. The hours people work, 
the services that you offer, the way 
you collect fees, the way you promote 
your product. 



Another reinventing activity is to focus on the 
outcome. Empower your customers. Make them part 
of your outcome process. We have for too long looked 
at process and frankly, your largest funder - the people, 
don't care what you are doing. They care what their 
dollar is buying. As we do now, but with even greater 
emphasis, we shift our resources to prevention. If, in 
fact, we move towards a healthcare reform that 
provides access through a card or some kind of 
payment source, in that people will be able to get 
tertiary care and specialty health services other places, 
why would we continue to offer that? Why would we 
not try and beef up the other end of the health-illness 
continuum? 

Another habit that you must break away from is trying 
to do it all yourselves. You must focus on catalyzing 
all sectors of the community to solve problems. You 
should not, nor can you, own all these problems ir) 
isolation. The days of government fixing and 
government taking care of it are no longer, because 
people are not willing to finance what it takes in order 
for us to do that. 

So again, the roles that I have spoken about earlier, 
about the convener and the facilitator and the partner, 
are critical in order for you to reinvent yourself. I 
would also challenge, that you begin earning money 
rather than spending it. And lastly, in your new 
reinventing mode, you need to shift the focus and this 
is not just a word game. Along with this goes a 
change in attitude, goes a change in performance, goes 
a change in mission, goes a change in organization. 
Look what's happened after July, 1993 in lllinois'local 
health departments. Very different, very much in 
keeping with the three core functions and frankly, very 
much in a unique market nitch. 

.... How will you survive? 

.... What are the signs of change? 

.... How will you know you've made a difference? 

First of all you must have leadership . Each of you are 
in a leadership role in your health department. 
Leadership does not have to come from the top down! 
It can come from anywhere in an organization and 
move in any direction. I would highly encourage you to 
assume your role. The last four years CityMatCH has 
been putting on these conferences we have all learned 
together wonderful skills as to how to become leaders. 
Your leadership will emanaie up as well as emanate 
down. 



24 



Second, there's got to be an attitude 
change! We are not doing business as 
usual! 

Third, you have to replace bureaucratic 
thinking, with entrepreneurial thinking. 

Fourth, you must move from 
parochialism to embracing/ 
encompassing strategies. 

Fifth, you're quick, you are responsive, 
you are customer conscious. You are 
no longer slow, doggy, or 
non-responsive. 



The reason I believe so strongly in rationally-based 
crime prevention policies is because they offer so 
much more hope than our current policy path. On the 
one hand, if this country follows its current trends, by 
the year 2053 we will have over half of our population 
in prison, without any corresponding increase in safety. 
That, of course, is unaffordable and it's terrible public 
policy. On the other hand, there is plenty of 
documentation supporting the proposition that crime is 
not destinv. that criminals are not born, they are made. 
Our country is very effective at creating criminals. Let 
us become effective at reversing our course and 
creating more productive citizens. 



A final thought. In this fast paced 
reform environment, local health 
departments need to prepare to be 
pro-active and develop their 
infrastructures to carry out the three 
core public health functions. We are 
held accountable by our public with 
different standards than the private 
sector. Our public pays for our 
slowness, lack of vision, lack of 
responsiveness. On the other hand the 
private sector has been allowed to fail 
it's way to success for centuries. 



25 



26 



School-Based Clinics and 
Local Health Departments 

Paul Melinkovich, MD 

Associate Health Director, Community Health Services 
Denver Department of Health and Hospitals 
Denver, CO 



Monday 

September 19, 1994 



The following material is from the slide 
presentation by Dr. Melinkovich on 
"The Denver Experience." 

Original Staffing Model 

1 . Services for non-SBHC students - 
school staff: 

a. school nurse 

b. school social worker 

c. school psychologist 

2. Services for SBHC students - SBHC 
staff: 

a. nurse practitioner/physician 
assistant 

b. health clerk 

c. substance abuse counselor 

d. mental health counselor 

e. medical director 

f. others 

Lincoln High School: Percent 

Distribution by SBC Non-Registrants, 
SBC Non-Using Registrants, and SBC 
Patients, 1987-88 through 1991-92 

1987-88 

80% not registered with SBC 

20% registered with and using SBC 

1988-89 

65% not registered with SBC 

10% registered with but not using 

SBC 
25% registered with and using SBC 

1989-90 

40% not registered with SBC 

15% registered with but not using 

SBC 
45% registered with and using SBC 



1990-91 

35% not registered with SBC 

20% registered with but not using SBC 

45% registered with and using SBC 

1991-92 

25% not registered with SBC 

30% registered with but not using SBC 

45% registered with and using SBC 

Lincoln High School SBC: Percent Distribution of 
Registrants by Source of Insurance, 1991-92 

25% No Insurance 

15% Medicaid 

25% Other Private Insurance 

20% HMO or PRO 

15% DHH Indigent Care Program 



Visits and Provider Type 
Visits - 7,598 



School Year 1 992-93, Total 



42% Mid-level Practitioner 

23% Substance Abuse 

3% Violence Prevention 

4% Physician 

28% Mental Health 

Visits by Primary Diagnosis - School Year 1992-93, 

Total Visits (All Sites) - 7,598 

14% Substance Abuse 

4% Chronic Condition 

2% Other Conditions 

7% Reproductive Health/STDs 

18% Acute Illness 

3% Acne/Other skin Condition 

1 1 % Physical Exam 

41% Mental Health 



27 



Community Partners 

1 . University of Colorado Health 
Sciences Center 

a. School of Medicine - Evaluation 

b. School of Nursing - Education 

2. The Children's Hospital 

Tertiary Care 

3. The Denver Department of Social 
Services 

- Child Welfare 

4. The Mental Health Corporation of 
Denver 

Mental Health 

5. Arapahoe House Substance 
Treatment Program 

Substance Treatment 



6. The Mayor's Office 

Political Support 

7. The Denver Department of Health & Hospitals 

Medical/Nursing Care 
Administration 

New Staffing Model School Health Care Team: 
Multidisciplinary Team 

1 . School Nurse/Nurse Practitioner 

2. Health Technician 

3. School Social Worker 

4. School Psychologist 

5. Consulting Pediatrician 

6. Mental Health Worker 

7. Substance Abuse Counselor 



TB Reemerges in Urban Communities: 
Implications for MCH 



Monday 

September 19, 1994 



The next three articles are based on the TB experiences in three U.S. cities. 



Hugh F. Stallworth, MD 

Health Officer & Director of Public Health 
Orange County Health Care Agency 
Santa Ana, CA 

Background. Orange County's 

population consists of 64.5% White, 
23.4% Hispanic, 9.6% Asian and 
Pacific Islanders, 1.6% Black, 0.4% 
Native Americans, and 0.5% Other. 



2) Low level of knowledge in the community about 
the signs, symptoms, and transmission of TB; 

3) Low level of knowledge amongst physicians about 
the diagnosis, treatment, and reporting of TB; and, 

4) Lack of preparedness in our internal TB program. 



Current issues faced by the community 
include: 

1) Rising HIV/AIDS rate, 

2) Increasing rate of immigration from 
countries where TB is endemic, 

3) Increasing rate of homelessness, 
and 

4) Overcrowding in correctional 
institutions. 

What Contributed to the TB Outbreak? 

1 ) Low level of awareness that TB is 
a major issue; 



Lessons learned. First, the community needed to be 
educated about TB (signs, symptoms, and 
transmission). Second, physicians needed to be 
educated and a strong public/private link established. 
We also realized our own Public Health TB programs 
need to be strengthened, and that legislation was 
necessary. 

Community education was approached through a TB 
Communication Plan that took into account the target 
audience(s), message(s) that needed to be sent, and 
potential communication barriers. 

Efforts to improve physician knowledge and 
public/private linkages included the use of hospital 



28 



grand rounds, private physician 
consultations, hospital discharge 
planning coordination, presentations at 
minority physician association 
conferences, offering TB seminars with 
CME credit, and by publishing and 
disseminating articles through local 
medical and public health journals, 
bulletins, and newsletters. 

Public Health TB programs were 
strengthened through the development 
of a TB control plan, implementation of 
a regular review of Orange County's TB 
control program (structure, efficiency, 
knowledge, and procedures), use of 
enhanced surveillance efforts by hiring 
a masters level Epidemiologist, and 
development of updated protocols and 
procedures, including contact tracing, 
DOT, and case management. Orange 
County also sought to enhance 
coordination with private providers by 
designating a PHN to act as a liaison, 
as well as working to establish and 
nurture contacts with physicians and 
leaders in ethnic minority communities. 



Five major legislative efforts were supported: 

1) First, health care professionals are required to 
report identification of a case or suspected case of 
TB to the local Health Department within 7 days. 

2) A health providers' report will include an individual 
treatment plan consisting of the name of the 
physician who has specifically agreed to provide 
medical care, and other pertinent clinical or 
laboratory information required by the local Health 
Officer, such as drug susceptibility results. 

3) Physicians must keep written documentation of 
each patient's adherence to the individual 
treatment plan, as well as report to the local Health 
Department a patient who stops treatment. 

4) Before a patient with known or suspected TB is 
discharged from a hospital or transferred to another 
facility, the Health Officer must receive and 
approve the individual plan. 

5) Finally, health care professionals must examine, or 
refer to the local Health Officer for examination, 
all household contacts of TB patients. 



Grace Rutherford, RN, MS 

Medical Coordinator 
Garland Health Department 
Garland, TX 

The Garland Health Department is a 
suburban Health Department. It is 
located in the Southwestern U.S. and 
adjacent to a large city (population one 
million) that has a tuberculosis rate that 
ranges from 2 to 272 times the national 
rate. Garland has seen an increase in 
peoples from those countries listed as 
high risk for TB by the Center for 
Disease Control. 

Twenty-two percent of Garland's 
180,635 population is non-white. In 
1991 the possibility of imported TB 
was suspected. A foreign-born adult 
population was targeted, tuberculosis 
skin testing those adults when they 



brought their children to immunization clinics. The 
children of those foreign-born adults are also TB skin 
tested at age 4 years and 14 years. The yield of 
positive reactions is approximately 20%. 

The school district and one emergency depaprtment 
assist in reading the skin tests. Follow-up telephone 
calls and letters are also utilized. Many patients 
respond to the letters and return for a repeat skin test. 
As a result of the screening program the county health 
department now holds a TB clinic twice a month in 
Garland. 



29 



Gary Butts, MD 

Deputy Commissioner 

New York City Department of Health 

New York, NY 

In 1990, New York City's population 
was 7.3 million, according to the U.S. 
Census. Nearly a quarter of the total, 
or 1 .8 nriillion, were children and youth 
under twenty years of age. 
Approximately 32 percent were Latino, 
31 percent African-American, 29 
percent White, and 7 percent Asian or 
other category. 

Twenty percent of the children and 
youth between 0-17 years of age in 
New York City in 1 990 were estimated 
to have no health covereage. In 1992, 
1,032,954 of the population 0-12 
years of age were enrolled in Medicaid. 
Another 25,000 children age 0-12 
were enrolled in the state sponsored 
Child Health Plus insurance program by 
the end of 1993. 

The Infant mortality rate (IMR) in New 
York City has steadily declined from 
1 3.2 per 1 00,000 live births in 1 988 to 
10.2 in 1992. There is still a 
significant disparity in IMR between 
Black and White infants. 

A 1991 survey of immunization status 
of preschoolers found only 38% of the 
children had complete immunizations 
by age two. Although New York City 
has not reached its potential, a variety 
of approaches aimed at parents and 
providers could help the Department of 
Health to achieve 90% immunization in 
the future. 

Tuberculosis cases in New York City 
decreased 1 5% in 1 993. This was the 
first significant decrease in 15 years. 
However, New York City continues to 
have three times as many cases as any 
other city in the country and four and 
half times the national case rate. 



The real-time trend in tuberculosis cases indicate that 
culture confirmed cases have decreased even more 
dramatically than all cases, as a reflection of improved 
case confirmation procedures for clinically-confirmed 
tuberculosis. Cases in females have decreased less 
than cases in males. Reasons for this are unclear; 
continued rising HIV sera-prevalence among females is 
one potential explanation. 

Cases by sex and age in New York City indicate that 
the group with highest case rates are males age 25-54 
and females age 25-44. From 1990-1992, cases 
increased steadily in most age groups. In 1993, most 
age groups experienced significant declines; persons 
over 65 were one exception to this trend. 

TB cases in children decreased between 1991 and 
1 992 and stayed relatively constant between 1 992 and 
1 993. However, there was a 30% decrease in culture 
confirmed cases in children under 15 in 1993. This 
strongly suggests that cases in children have continued 
to decline, but that the consistent numbers of verified 
cases reflect improved case verification procedures for 
children with negative cultures. 

African Americans continue to make up more than half 
of all TB cases in New York City. From 1985-1992, 
cases in New York City increased slightly among 
Asians and Whites and dramatically among Hispanics 
and African Americans. In 1993, cases decreased 
most dramatically in African Americans and Hispanics. 
Cases also decreased among White New Yorkers, but 
increased slightly among Asians. 

Cases in New York City by age, race, and ethnicity 
indicates that in Whites, Hispanics and African 
Americans, the peak case rates are in the 35-44 age 
group. In contrast, Asians over 65 have the highest 
rates of any Asians. In 1 993, for the first time Asians 
over the age of 65 had a higher case rate than any 
other race/ethnic group. 

Case rates by borough indicated that rates are highest 
in Manhattan, but that Brooklyn accounted for more 
than one third of TB cases in New York City. 1993 
was the first time since 1 978 that Brooklyn had more 
TB cases than Manhattan. 



30 



Foreign born cases in New York City 
have increased steadily as a proportion 
of all cases, from 21 % in 1 990 to 27% 
in 1993. Cases among the foreign 
born increased slightly in New York 
City in 1993. 

HIV status of cases by sex, indicates 
that 36% of males and 23% of females 
were documented and reported to be 
HIV seropositive. These figures do not 
include individuals who are HIV tested, 
but whose HIV results were not 
reported to the Department of Health. 

Causes of the decrease in tuberculosis 
are undoubtedly multifactorial. The 
expansion of directly observed therapy 
as well as decreased spread in the 
congregate settings of hospitals, 
shelters, and jails are undoubtedly 
leading causes. Between 1984 and 
1994, directly observed therapy 
increased dramatically in New York 
City. Most directly observed therapy is 
provided by the City Department of 
Health. 

It is possible to arrive at a rough 
estimate of savings from the decrease 
in 1993. If previous trends had 
continued, there would have been an 
estimated 1 ,000 more cases than there 
actually were. At $25,000 per case, 
this is $25 million. In addition, directly 
observed therapy undoubtedly 
prevented many re-hospitalizations of 
patients who would have become ill 
again if they had not been taking their 
medication. 



These are minimum estimates - more hospitalization are 
likely to have been prevented and the estimates 
presented here do not include prevention of secondary 
cases and TB infections. 

There are important lessions to be learned from the 
rapid decrease in cases of TB in New York City, by 
patients, the health care system and society at large. 

The Ten Principles of TB Care 

Medical providers and health-care workers must be 
alert for the possibility of TB and provide appropriate 
care. The ten principles of TB care are: 

1 . If a patient has a chronic cough, fevers, weight 
loss, night sweats... Think TB. 

2. Report all suspected or confirmed cases of active 
TB to the Department of Health within 24 hours 
of diagnosis. Mandated by law and essential for 
TB control. 

3. Offer HIV counseling and testing. Prophylaxis and 
treatment are extended for those who are HIV 
positive. 

4. Obtain a careful history, especially to identify 
contacts and document prior treatment with 
anti-tuberculosis medication. 

5. In New York City, the appropriate anti-TB 
medications for never-treated cases or suspects 
are isoniazid, rifampin, pyrazinamide and 
ethambutol. 

6. Ideally, all TB patients should be placed in directly 
observed therapy (DOT). 

7. Every effort should be made to provide "patient 
friendly" services. 

8. Never add a single drug to a failing regimen. 

9. Monitor patient progress by taking monthly 
sputum smears and cultures. 

10. Seek expert consultation in the management of 
the TB patient. 



31 



Women's Health 1994: 
of Concern to Women 



Three Health Issues 



Monday 

September 19, 1994 



Women's Health: Colposcopy Services 

Margaret Gier, RNC, MS 

Manager, Women's Health Progranns 
Tri-County Health Department 
Englewood, CO 

Tri-County Health Department ensures 
the public health of about 839,507 
people in the 3000 square nnile area 
which surrounds the city and county of 
Denver, Colorado. The departnnent has 
212 ennployees, 7 office sites and 65 
progranns in Environmental Health, 
Personal Health, Education and Vital 
Statistics. 

Beginning with the publication of 
"Healthy People" in 1979, and through 
the 1 980 "Promoting Health/Preventing 
Disease" and the 1990 "Year 2000" 
objectives, cervical cancer in women 
was recognized as a significant health 
issue. But no one realized to what 
extent the problem would develop 
before the cause was even apparent. 
The HPV virus which was virtually 
unheard of a few years earlier, by 1 989 
had surfaced as the number one cause 
of all cancers of the lower genital tract, 
male and female. 

The PAP test is usually the first 
indication of the presence of HPV and 
to pinpoint its exact location the genital 
area is scanned with a colposcope, a 
binocular like magnifying tool. With 
thousands of women needing this 
evaluation yearly in the state of 
Colorado, many of the uninsured were 
going untreated. 



The Colorado Legislature responded in 1 989 with a 
special appropriation of $50,000 to assist with the 
purchase of equipment, the training of staff, and for 
the diagnosis and treatment of uninsured women. 
Using the funds from the Legislature as seed money, 
Tri-County Health Department purchased, borrowed 
and bargained for the equipment to set up an in-house 
colposcopy clinic. 

In that first year over 200 colposcopies were performed 
and every women who needed one had it done. With 
reimbursement from the legislative fund the following 
year and a small co-pay from clients of $5 to $25, the 
program was soon self sufficient. By 1992 there was 
enough surplus to purchase a new colposcope and a 
LEEP apparatus. 

In 1993 we began to see a decline in the rate of 
abnormal PAPs, but the incidence of HPV as the cause 
for abnormality is now nearing 100%. The severity of 
the disease also shows evidence of increase over the 
past year. Many more cases of severe dysplasia and 
carcinoma in-situ are appearing. 

The need for this service is not going to go away soon. 
This is a very worthwhile public health service and one 
that can easily be started up in any area where the 
abnormal PAP rate is high. Funding is now available in 
many states from the Wasman Breast and Cervical 
Cancer Screening Grant. Once established the program 
becomes self sufficient and rewarding as the cure rate 
for cervical dysplasia and early cervical cancer continue 
to be very high. 



32 



CityMatCH Spotlights MCH "Success Stories" 



Tuesday 

September 20, 1994 



Presentation of the annual CityMatCH 
"Urban MCH SpotLight" recognitions 
for innovative urban healtli department 
MCH initiatives continued to be a 
popular conference feature in 1994. 
The three health departments 
recognized as "SpotLight" finalists 
were Duval County Public Health 
Department (Jacksonville, FL), 
Metropolitan Health Department of 
Nashville/Davidson County (Nashville, 
TN), and the Philadelphia Health 
Department (Philadelphia, PA). 

The selection process was based on 
profiles submitted by invited city and 
county health departments attending 
the conference. The profiles were 
evaluated on four selection criteria: 

• innovation 

• demonstration of health 
department leadership 

• use of existing resources 

• reaching the hard the reach 

Representatives from each of the 
recognized health departments, 
provided brief overviews of their 
initatives and how they exemplified the 
selection criteria. Hats off to the 
Philadelphia Health Department, who 
made it possible for four employees 
with front line responsibility for their 
highlighted initiative to be present for 
the recognition ceremony. Here is a 
brief description of each highlighted 
initiative; for more details please refer 
to pages 104, 146, and 164 
(respectively) in the "Profiles" section. 



Improving EP Services by Networking 

Duval County Public Health Department 
Jacksonville, FL 

CityMatCH Contact: Donald Hagel, MD 
(904) 354-3907 

Effort to provide comprehensive care coordination and 
case management of post partum patients. Public 
health nurses are placed at key hospitals to assure new 
mothers are counseled, started on an appropriate birth 
control method, and further assisted in receiving 
referral services for newborn care and other family 
health needs. 

Metropolitan Nashville Stroke Belt Initiative 

Metropolitan Health Department of Nashville/ Davidson 

County 

Nashville, TN 

CityMatCH Contact: Betty Thompson, RN 

(615) 340-5648 

Community-based risk factor reduction initiative 
designed to reduce stroke in the African American 
community. The key element of the initiative is the 
development of working partnerships with African 
American churches to address health disparities in the 
African American population. All activities are planned 
by the churches with support from the Health 
Department. 

School Health Social Work Problems 

Philadelphia Health Department 
Philadelphia, PA 

CityMatCH Contact: Susan Lieberman 
(215) 685-6827 

Collaboration between the Office of Maternal and Child 
Health, Philadelphia Department of Public Health, and 
the School District of Philadelphia. Social worker from 
the Office of Maternal and Child Health are stationed at 
the two elementary schools in North Philadelphia, 
working in partnership with the school nurse to 
enhance the health and support services available to 
children from pre-school to grade five. 



33 



34 



Closing Remarks 



Wednesday 

September 21, 1994 



Carolyn B. Slack, MS, RN 

Chairperson, CityMatCH Board of Directors 
Administrator, Family Health Services 
Columbus, OH 

"Effective leadership during times of 
transition." I really needed this now. 
I needed this conference. I needed this 
time away. I needed to connect to nay 
colleagues from across this country. 
And, I particularly needed to hear and 
learn about effective leadership in times 
of transition. 

While preparing for these remarks, I 
thought about transitions. Like most of 
you, there are many transitions in my 
city in the health care environment. 
Mandated managed care, hospitals 
downsizing inpatient services and 
increasing their outpatient, home care 
and community outreach programs and 
the list could go on. The more I though 
about our transitions, I was reminded 
of transitional labor. When I thought 
about our responses to transitions, I 
discovered that these are the very 
signs and symptoms of transitional 
labor identified in nursing texts. Some 
of the non-physical signs/symptoms are 
the following: feelings of frustration; 
fear of loss of control; irritability 
surfaces; and vagueness in 
communications. In addition, probably 
what makes these transitional labor 
signs/symptoms worse for many of us, 
is the fact that this "pregnancy," for 
which we are laboring, was most likely 
mistimed, unplanned or maybe even 
unwanted. 

The work we have ahead of us at home 
is going to be difficult. Many of us are 
or will experience changes in how our 
local public health department is 
organized and financed. We may see 
changes in what we do every day. 
Because of the many pending changes 
in our health departments, I believe our 



organization, CityMatCH, takes on an even more 
pivotal role. As a result of our "re-engineering" we are 
in a better position to improve our organizational 
infrastructure so that we can develop our capacity to 
function more effectively as local leaders for children 
and families and respond to and develop appropriate 
policy. 

This conference has offered us numerous opportunities 
to learn how to cope and manage complexity and 
change. We have worked closely together as a 
learning community for the last 5 days. It is time for 
each of us to commit to what we will do at home 
tomorrow. I am taking three main ideas home with me. 

First, the data and program evaluation workshops have 
reinforced the importance of data analysis and 
evaluation as major public health products. I have 
some personal commitments as a result of this: 

1 . Study time - 1 need to keep learning and practicing 
what I learn; 

2. Sharing the data - I need to make sure that any 
data collected by programs is fed back to staff; 

3. Data based decision making - I need to assure 
that data are used to inform not only policy, but 
program planning and service delivery. This must 
be a very visible process. 

Second, everything we do needs to be framed within 
the context of core public health functions. I need to 
"speak" core functions more. We need to help staff, 
and the public, understand and see core functions in 
what we do. Each person's job should have tasks and 
be evaluated as doing or supporting the core functions 
of assessment, policy development and assurance. I 
need to make the connections clear and make sure my 
colleagues are doing the same. 

Third, I go home with a renewed commitment to our 
organization - CityMatCH. CityMatCH is an 

organization of and for urban health department MCH 



35 



leaders. Our effectiveness depends on We have spent 5 days learning about effective 

our members articulating the issues, leadership. We are members of an organization of 

concerns and solutions to one another, leaders for leaders. By virtue of our presence and 

based on data, of course, and within participation in this conference, we are ready to return 

the context of core public health home as more effective leaders and members of this 

functions. It is imperative we organization, 

communicate with each other. 

Have an effective and productive year. And, please, 

We are here as empowered persons. call me. 
Our Health Officers have designated us 
as the MCH leader within our local 
health department. 



36 



CITIES INCLUDED IN 1994 PROFILES: 



City 



Page 



City 



Page 



Akron, OH 


42 


Miami, FL 


134 


Albuquerque, NM 


44 


Milwaukee, Wl 


136 


Allentown, PA 


46 


Minneapolis, MN 


138 


Anchorage, AK 


48 


Missoula, MT 


140 


Austin, TX 


50 


Mobile, AL 


142 


Baltimore, MD 


52 


Modesto, CA 


144 


Berkeley, CA 


54 


Nashville, TN 


146* 


Birmingham, AL 


56 


Newark, NJ 


148 


Boise, ID 


58 


New Haven, CT 


150 


Boston, MA 


60 


New York City, NY 


152 


Charlotte, NC 


62 


New York City, NY 


154 


Chicago, IL 


64 


Norfolk, VA 


156 


Colorado Springs, CO 


66 


Oklahoma City, OK 


158 


Columbus, OH 


68 


Omaha, NE 


160 


Dallas, TX 


70 


Peoria, IL 


162 


Dayton, OH 


72 


Philadelphia, PA 


164* 


Denver, CO 


74 


Phoenix, AZ 


166 


Detroit, Ml 


76 


Pittsburgh, PA 


168 


Durham, NC 


78 


Portland, ME 


170 


El Paso, TX 


80 


Portland, OR 


172 


Englewood, CO 


82 


Raleigh, NC 


174 


Eugene, OR 


84 


Rochester, NY 


176 


Evansville, IN 


86 


Salem, OR 


178 


Flint, Ml 


88 


Salt Lake City, UT 


180 


Garland, TX 


90 


San Diego, CA 


182 


Gary, IN 


92 


San Jose, CA 


184 


Grand Rapids, Ml 


94 


San Juan, PR 


186 


Grand Rapids, Ml 


96 


Santa Ana/Anaheim, CA 


188 


Greensboro, NC 


98 


Santa Rosa, CA 


190 


Indianapolis, IN 


100 


Seattle, WA 


192 


Jackson, MS 


102 


Spokane, WA 


194 


Jacksonville, FL 


104* 


St. Paul, MN 


196 


Kansas City, KS 


106 


St. Petersburg, FL 


198 


Kansas City, MO 


108 


Stockton, CA 


200 


Knoxville, TN 


110 


Tacoma, WA 


202 


Lakewood, CO 


112 


Tucson, AZ 


204 


Lansing, Ml 


114 


Washington, DC 


206 


Laredo, TX 


116 


Wilmington, DE 


208 


Lexington, KY 


118 






Lincoln, NE 


120 






Long Beach, CA 


122 






Los Angeles, CA 


124 






Louisville, KY 


126 






Madison, Wl 


128 






Memphis, TN 


130 






Mesquite, TX 


132 


• 1994 SpotLight Recognition Recipients 



37 









Reaching Out to Urban MCH Populations 


1994 


Women's Health Perinatal Health Child Health Adolescent Health Other 


Profiles of 

Urban 

Health 

Department 

Initiatives 


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Ateoft, Oh» 








♦ 


« 


♦ 




































Atouquetque, New Mexico 




















♦ 




























ABertown, PeiHrayivama 




















♦ 










• 


« 










• 






Anchoraqe, Alaska 




« 












































Austin, Texffi 




♦ 




« 












♦ 




• 




















♦ 




Ballimore, Maryland 






































♦ 










Berkeley, Callfomia 




♦ 








♦ 
























♦ 




♦ 


♦ 






BItminqham, Alabama 




















♦ 




























Boise, Idaho 












































♦ 




Boston, Massachusetts 




























♦ 




















Ctailotie, North CarolfnB 


















♦ 






























Chcaxja Winois 




















♦ 




























Colorado SpHnifs. Colotado 


























♦ 






















C(A»nbos, Ohio 












4 


♦ 








« 






♦ 




















Oafias, Texas 












♦ 








« 


• 


























Dayton, Ohio 


























♦ 






















Denvei, Coloiado 




















♦ 




























Detroit, Michigan 














♦ 


































Durham, North Carolina 








♦ 








































El Paso. Tews 
















































ErKjIewood, Colotado 
















« 
































Eugefie, Oregon 








♦ 




♦ 


♦ 


































EvansviBe, Incbaoa 












♦ 




































flint, Michloan 
























• 
























fiaitemd. Texas 












































* 




Gary, Indiana 
















































Grand Rapids. Michigan 




















♦ 










« 


















Greensboro. North Carolina 




















♦ 




























Indianapolis. Indiana 












♦ 




































Jackson. Mississippi 










♦ 






































JacksofMile, Flwida 




« 














♦ 






























Kansas Citv, Kansas 








♦ 






♦ 


































Kansas Citv, Missouri 


















♦ 






























Knoxville, Tetmessee 
















































lakewood, Coioiado 
















































Lansing. Michigan 














♦ 


































Laredo. Texas 




















♦ 




























Lexington, Kentucky 


♦ 








♦ 






































Lincoln, Nebraska 








♦ 






♦ 


























♦ 








Long Beach, Calitornia 








♦ 






♦ 


































Los Angeles, California 
















































Louisville, Kentucky 
















































Madison, Wisconsin 




















t 




























Memphis, Tennessee 








* 






































3 






















♦ 




-L. 


_!_ 




















_J 



00 *Key: 1 =Neural tube defects: 2=Foster care: 3=Aclult education: 4=Job training 



1994 


Improving Access to Care 
for Urban Children and Families 


Strengthening Urban Public Health 
Systems for MCH 


Profiles of 

Urban 

Health 

Department 

Initiatives 


"55 

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♦ : 




♦ 
























Andwrape, ftksJo 














































Austin, Texas 






















♦ 














♦ 










Baltimore, Maryland 














































Berkeley, California 














































Birmingham, Alabama 


















♦ 


















♦ 




♦ 






Boise, Idaho 














♦ 








♦ 
























Boston, Massachusetts 














































sisi^barbtte, NoflfcCaroftna : 


















♦ 




























iii|)(iag(>,;tiiw3(s:;v 














































iiSoiofadoSpj^ngSv Ccfcwdo 






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ifC«tiiun^s,iOhro 




































♦ 










|i||llas, Texas 






♦ 














♦ 


♦ 
























Dayton, Ohio 














































Denver, Colorado 














































Detroit, Michigan 














































Durham, North Carolina 














































iilifeo,1ixas: :.■ 












♦ 


































Isii^iewoodi C<3fcimdo 















































il^efl«,:0«9on 






♦ 


















♦ 






















litplsnswJte, Miana 






















♦ 














♦ 










■::f fa, Michigan ;■ : 


♦ 


































♦ ■ 










Garland, Texas 














































Gary, Indiana 




♦ 










♦ 








♦ 














♦ 










Grand Rapids, Michigan 




♦ 


♦ 












♦ 


♦ 
















♦ 




♦ 






Greensboro, North Carolina 






♦ 












♦ 


















♦ 










Indianapolis, Indiana 


















♦ 




























Jackson» Misssapj» 














































Jacksoftviffe, Ftoiida 






•♦ 


















; 












♦ 










; Kafi3asCS^,Kas^s 
















: 






























Kansas City, Missoufi 
















; 






























; Knoxvite, THWessee 








































♦ 






Lakewood, Colorado 












































♦ 


Lansing, Michigan 














































Laredo, Texas 




♦ 


♦ 












♦ 


















♦ 










Lexington, Kentucky 














































Lincoln, Nebraska 


♦ 
















♦ 




























Long Beach, California 














♦ 




♦ 






♦ 












♦ 










LosAnq©tes,Caliomia 


































♦ 












Louisvitte, Kentucky 














♦ 
































Madison, Wisconsin 






♦ 












♦ 


















♦ 




« 






Memphis, Tennessee 


















♦ 




























MesquJte. Texas 















































39 



1994 






Reaching Out to Urba 


nMCI 


^ Populations 


Women's Health Perinatal- Health 




Child Health 


Adolescent Health Other 


Profiles of 

Urban 

Health 

Department 

Initiatives 


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o 

o 
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c 
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o 
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2 « 
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11 


* 

5 


Mismi. Florid 








♦ 








































Milwaukee, Wisconsin 
















































Mmneapois, Minnesota 




























♦ 










♦ 










Wisstxila, Montana 




















♦ 




























«obfe. Atebama 














♦ 


































Modesto, California 


« 






♦ 








































Nashville, Tennessee 
















































Newark. New Jersey 












































♦ 




New Haven, Connecticut 












♦ 










♦ 


























New York, New York 








♦ 


♦ 
















♦ 






















NoifoBt, Vitgm 






































■ 


« 








Oklahoma CKy, Oklahoma 
















♦ 
































Oinaha, Nebraska 
















































Pewia, IS«ois 


















♦ 


♦ 






























































♦ 














Phoenix, Arizona 








♦ 


♦ 


♦ 


♦ 


































Pittsburgh, Pennsylvania 
























* 


♦ 






















Portland, Maine 
















































Portland, Oregon 










































« 






Raleigh, North Carolina 




































♦ 












Rodiester, New Ywk 


















♦ 






























Sti em. Oregon 








* 


















♦ 




















i 


Sift Lake Cl^.Uttth 








♦ 


♦ 
















4 






















San D>«90, CaSfunIa 
















































Sen Jose. CaittorniB 
















































San Juan, Puerto Rico 




















♦ 




























Santa Ana/Anaheim, CA 
















































Santa Rosa, California 
















































Seattle, Washington 


































♦ 














Spokane, Washington 


♦ 










♦ 




































St Paul, Ugmesola 




















« 




























Si Petersbwg, Ftoiida 












♦ 




































Stockton, Cafiiwnia 






























♦ 


















Tacoina, Washington 


































♦ 










♦ 




Tucson, Arizona 












































♦ 




Washington, DC. 
















































Wilmington, Delaware 




♦ 


♦ 


♦ 




♦ 





































































































































































































































































































































































































































40 



*Key: i=Neural tube defects: 2=Foster care: 3=Aduit education: 4=Job training 



1994 


Improving Access to Care Strengthening Urban Public Health 
for Urban Children and Families Systems for MCH 


Profiles of 

Urban 

Health 

Department 

Initiatives 


1 

60 

•a 

•s 

1 
1 S 

60 'g 


1 

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60 

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60 

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C 

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> 
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iiSwirii.Piontte : 


♦ 
























♦ 










♦ 










MSwauke^.WtSCooa* 






































♦ 








Mitae^is, MinnegotB 






































♦ 








IfeEOUfeMpntoa . 












: 


































: Wobife.Aiaiiama : 














































Modesto, California 














































Nashville, Tennessee 








♦ 






































Newark, New Jersey 














































New Haven, Connecticut 


♦ 


















♦ 


♦ 














♦ 










New York. New Yorl( 














































; i*)rfoilt:Vir5»ta 














































: ■0)#)»?ra;eit;^,;DkiahoiTia :; 














































OmshaNebrgska 
































♦ 






♦ 








Peor^iinafe 














♦ 
































iiiiiiiife PHtnsyf^ania 












♦ i 
























♦ 










Phoenix, Arizona 






















♦ 














♦ 










Pittsburgh, Pennsylvania 




♦ 


♦ 








♦ 






















♦ 










Portland, Maine 












































♦ 


Portland. Oregon 














































fiafeigtj. North Carofoa 












♦ : 










♦ 
























8ocii$sfer, Mew York 














































; Ssfen, Oregon 




































♦ 








♦ 


liiiLaksCity, Utaii 






♦ 








♦ 










♦ 






















pi^jBi^gi^C^iHiiia : ? 




























♦ 


















San Jose, California 




























♦ 


















San Juan. Puerto Rico 














































Santa Ana/Anaheim, CA 




































♦ 










Santa Rosa, California 




























♦ 


















Seattle, Washington 














































■ S|)6kaBe,W8sHin^B 














































a Paiii, Mmnesola 




































♦ 










S. Psteratsutg, FbtHf^ 














































Stod(ton,CaScraia 














































tscoina.:)iVashffl5lofl 




♦ 


♦ : 






♦ 
























♦ 










Tucson. Arizona 














































Washington. D.C 




















♦ 




♦ 


♦ 




















Wilmington. Delaware 






































































































































































































































































































































































































•::.■:■;.?: 




^^^^^^ 





















41 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



City of Akron 
Akron, OH 

Beverly Parkman 
216/375-2369 



CONTACT FOR MORE INFORMATION: Chris Richmond (216/773-6838, FAX: 216/773-0348) 



la. Initiative Name: Lifelink-Prenatal Outreach Program 

1b. Category(ies) that best applies to your initiative: 

Prenatal Health - 04 Prenatal care; 05 Expanding maternity services; 06 Home visiting 



Describe the initiative. Establishment of a "pilot" program of indigenous community health 
workers in an Akron neighborhood following the Cleveland Metro Health Medical Center 
model. Cleveland Metro Health studied three different research/service outreach programs 
and selected the one which resulted in the most significant decrease in infant mortality for 
continued programming. They saw an average reduction of 26% in infant mortality in 
targeted neighborhoods over three years. We've chosen to emulate their approach. 

Reduce the proportion of pregnant women in census tracts 5032 and 52034 who do not 
receive timely prenatal care from 39% to 10% by the Year 2000. (Over the past five 
years, 80 to 100 births have occurred in these census tracts annually, with 36 to 39 births 
occurring to women who started prenatal care late.) 

a. In conjunction with the East Akron Community House, hire five one-half time indigenous 
workers - women who are members of the targeted community. Train these women in 
the basics of pregnancy and prenatal care, and in effective interaction with clients and 
medical personnel. Give them the responsibility to find and encourage women to get 
regular prenatal care, including bonuses for women who start care in the first trimester 
and who keep at least 80% of their clinic appointments. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Summit County has three health departments and five hospitals that comprise 
the Summit County Prenatal Task Force. This group, Chaired by C. William Keck, MD, 
MPH, Director of the City of Akron Department of Public Health, developed the project 
which is based in a community service agency located in the target area. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes, as each committee and subcommittee of the task force meets, agency 
representatives at all levels work together to implement and improve care for pregnant 
women. 



42 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Systematic Barriers: women do not 
l<now how to access the system to care; do not 
have the proper or necessary documentation for 
care i.e. proof of pregnancy, information related 
to system enrollment. 

How overcome? The Life Link initiative has 
been able to access the system for these 
women, expedite their care by intaking 
necessary information prior to making 
appointments working with these moms on a 
one to one basis and provide time to explain the 
system and bureaucracy of receiving care the 
"this is how it is done" Also, the Life Link 
initiative has been successful in bringing a 
wraparound services approach w/coordination 
with hospitals /clinics/Department of Human 
ServicesAA/IC/etc. 



Barrier 2: Socio-demographic barriers: Women 
who have substance abuse problems. Teens 
who do not have family support. Women feel it 
is not necessary especially with repeated births 
basic ignorance to importance of early care. 

How overcome? The Outreach Workers have 
worked with the women one on one to get them 
into care and with training they have been able 
to enroll women w/substance abuse problems 
into care. This is done by ensuring the women 
that prenatal care and the substance problem can 
be treated. With teens, where family mediation 
is necessary Outreach Staff have referred and 
brought families back together or teens have 
sought guardians. Through information and 
education brought to the community, the 
importance of prenatal care is instilled. 



How is it funded? City/County/Local government funds; Specify: Summa Health System Akron 
General Medical Center, Cuyahoga Falls General Hospital, Childrens Hospital Medical. 



What is the approximate annual budget for this initiative? $125,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What are the major accomplishments to date? Objectives : 1 ) To 
enroll 55 women into care by Dec. '94; 2) to work with these moms/children through the childs 
first birthday; 3) To assist women w/prenatal care plan; 4) to inform/educate community to get 
women into early care - DATA COLLECTED? MONITORED - It is collected through the 
intake/enrollment forms and prenatal assessments. It is used to monitor the number of women 
of clinic visits (goal to have 80% of visits kept by moms), and follow through on immunizations. 
MAJOR ACCOMPLISHMENTS TO DATE : Since 3-21-94 when the project started, 40 women 
have been enrolled into care, 39 have maintained on going care. Women with children have 
been brought current on children's immunizations. Coordination and collaboration of services for 
nutritional needs, public aid, pregnancy educational child development services & classes have 
all been initiated due to Life Link. 

6b. Has this initiative been formally evaluated? At this time, no. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes, It 
is needed. 

Why? To get back to community based public healthcare. The program is in its sixth month 
and has exceeded our expectations, however we need at least a year of operation to evaluate its 
effectiveness. 

7b. Has this program been replicated elsewhere? No, not that we are aware. A public/private 
partnership has been established. 



43 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Bernalillo County Health Department 
Albuquerque, NM 

Sally Kennedy 
515/841-4125 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Albuquerque Preschool Immunization Demonstration Project 

1b. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 



Describe the Initiative. Albuquerque, NM had low preschool immunization rates. The goal 
of the demonstration project was to increase the age-appropriate preschool vaccination of 
children ages 0-24 months by decreasing barriers at the provider, consumer, and systems 
level. 

The 1 8 Standards for Pediatric Immunization Practices were the bases of the Project's 
objectives and activities. An intervention and control site were chosen to measure the 
impact of the interventions. These two areas are geographically adjacent but represent 
distinct communities within Albuquerque. 

The interventions focused on expanded immunization clinics, in-service training to public 
and private providers, linkage with the WIC program, increased community awareness 
about the importance of immunizations, and the use of a recall/reminder system. All of 
these interventions have continued even though the project has ended. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The public health department has increased the accessibility of immunizations 
and increased private providers' awareness of the immunization rates within Albuquerque. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? Yes, New collaborative activities with hospitals, civic organizations, and 
businesses have developed. 



44 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Limited accessibility to 
Immunizations. 

How overcome? Immunizations are given 
8-5, Including lunch time, Monday through 
Friday. Immunizations are available on a 
walk-in basis. They are offered In the 
evening, once weekly, with WIC. 



Barrier 2: Parents don't keep track of 
Immunizations needed by their children. 

How overcome? Letters are sent to parents of 
newborns to notify them of when to start 
Immunizations. All children enrolled In the 
clinic receive reminder letters. Parents are 
notified of missed immunizations. 



5. How is it funded? Other federal funds. 

What is the approximate annual budget for this initiative? $500,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? No. 
Process, Impact, and outcome evaluations were completed. These evaluation components 
relate to the 1 8 standards for Pediatric Immunization practices. The process evaluation 
monitors the structure of the program and the methods of operation. A pre- and 
post-Intervention survey was completed In the community. It measured knowledge, 
attitudes, and behavior. The Impact evaluation Included baseline, quarterly and post 
intervention assessment audits of clinic vaccination records, observational spot checks of 
clinics for missed opportunities, and implementation of the standards. The outcome 
evaluation measured the pre- and post-intervention Immunization levels. For the 
Intervention site the baseline Immunization was 53.4% and the post-intervention level was 
66.0%. Some of the barriers were decreased. 



6b. Has this initiative been formally evaluated? In process. 



7a. Do you think that this initiative would work if implemented in another urban community? 

Why? We were able to implement the most successful Interventions in other clinic sites in 
Albuquerque and other cities in New Mexico. Some of these same interventions could be 
successfully Implemented in other urban communities. 

7b. Has this program been replicated elsewhere? Yes 

If yes, where? 



45 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Allentown Health Bureau 
Allentown, PA 

Joanne Barham, RN, BSN 
610/437-7615 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Allentown Health Bureau Maternal and Child Health Program 

lb. Category(ies) that best applies to your initiative: 

Child Health - 10 Immunization; 15 Lead poisoning; 16 Children with special health care 

needs 

Adolescent Health - 21 Teen parenting 

Improving Access to Care - 25 Reducing transportation barriers; 32 Other outreach 

activities; 34 Case management/care coordination 



2. Describe the initiative. The Allentown Health Bureau's Maternal and Child Health (MCH) 
Program believes that services critical to health promotion and disease prevention include 
age-appropriate screening and immunization, health education, identification of special 
needs and referral, and facilitating linkages between clients and health care providers. The 
MCH program consists of the following components: 

Child Health and Advocacy : Provides intervention by community health nurses for children 
at risk due to medical or social needs. A case management approach is utilized for families, 
which includes home and family assessment, planning, intervention via home visits, health 
education or referrals, and evaluation. 

Immunization Program : Strives to improve immunization levels in the city so that 90% of 
preschool children are appropriately immunized by age 2 years, according to the year 2000 
objectives. 

Childhood Lead Poisoning Prevention Program : Continues to increase identification and 
management of children under 6 years with elevated blood lead levels. This includes 
education, screening, environmental, and medical management. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The leadership of the health department has been to plan the types of 
services provided, methods of intervention and evaluation, and communicating to providers, 
agencies, and the community about our new and unique services. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? It has been enhanced because the Health Bureau is the only agency in the city 
providing these services. The services are unique because they utilize a case management 
approach, and services are not limited to families due to third party reimbursement. 



46 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Community agencies and health 
providers becoming aware and utilizing our 
services. 

How overcome? Ongoing communication by 
phone and letters to these providers, reminding 
them of our services and encouraging them to 
use the program. 



Barrier 2: Financial component of dental 
program - funds are used very quickly due to 
severe need of services. 



How overcome? 1) Charitable work is being done 
by a group of 8 participating dentists. 2) Assisting 
clients in enrolling in Blue Chip, Mery, and Medical 
Assistance which will cover some care. 



5. How is it funded? City/County/Local government funds; MCH block grant funds. 

What is the approximate annual budget for this initiative? Advocacy/Dental $55,000; Child Health 
$30,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? The MCH program 
has specific, measurable objectives, which are monitored and evaluated on a quarterly basis. Data 
is collected via documentation in client charts (each family has a care plan which is evaluated 
continually during services), home visit logs, and community outreach activity logs. 
Accomplishments: Child Health and Advocacy - 1) 52 home visits completed between 5/6/94 and 
7/29/94; 2) 107 children were accessed to and received care by dental providers; 3) 210 children 
linked with primary care providers since 6/1/94; 4) 10 children accessed to health insurance 
coverage; and, 5) 4 health education workshops completed in July. Immunization Program - 1) 
Immunization coalition established to develop innovative methods of increasing immunization rates. 
Coalition consists of health care providers, school, business, and church leaders, and concerned 
citizens; 2) Celebration of National Infant Immunization Week including a mayoral proclamation, a 
school poster contest, and media coverage of events; 3) Development of satellite immunization 
clinics in senior centers; 4) Education materials developed and distributed to health care providers 
and social service agencies, including those serving the Latino community; and, 5) Mrs. Betty 
Bumpers and Mrs. Rosalyn Carter of Every Child By Two and Mrs. Ellen Casey, wife of Governor 
Casey, are to visit in support of the coalition's efforts on September 15, 1994. Childhood Lead 
Poisoning Prevention Program - 1) 50 children are currently in medical and environmental 
management; 2) The program screens 1,100 children per year; 3) Monitors and educates, on an 
ongoing basis, children with mild elevations. The program receives referrals averaging 10 new 
children per month; 4) New bilingual, low-literacy education materials were developed and 
distributed. Educational programs regarding lead poisoning prevention are provided to day care 
centers and social service agencies; and 5) Allentown Health Bureau completes full environmental 
testing vs. a previous outside agency. 

6b. Has this initiative been formally evaluated? Yes, on a quarterly basis. 

7a. Do you think that this initiative would work if implemented in another urban community? It would 
work in other urban communities. 

Why? Because of the need for the services and education; by using a case management approach 
and objectives, it is easy to evaluate the program. 

7b. Has this program been replicated elsewhere? Not that we know of. 

If yes, where? 



47 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Municipality of Anchorage, Department of Health & Human Services 
Anchorage, AK 

Carole McConnell 
907/343-6128 



CONTACT FOR MORE INFORMATION: Lynn Hartz, MSN, FNP (907/343-4623) 



la. Initiative Name: Colposcopy Project 

1b. Category(ies) that best applies to your initiative: 
Women's Health - 02 Family planning 



2. Describe the initiative. The colposcopy project was designed and implemented within the 
framework of a family planning clinic at the Department of Health & Human Services in 
response to an increasing rate of abnormal pap smears in the family planning population. 
The goal of the project is to prevent cervical cancer in teenagers and low-income women 
at-risk through early intervention and treatment. Clients with two consecutive atypical pap 
smears or one pap smear with cervical intraepithelial neoplasia are referred to the 
colposcopy clinic if they have no health insurance, fall within state poverty guidelines, or 
are less than 19 years of age. Colposcopy clinics are held twice a month and staffed by at 
least two nurse practitioners trained in colposcopy. A clinic held every other month is 
staffed by physicians who donate their time and sit on the Family Planning Medical 
Advisory Committee. The physician's clinic is used for consultation by the practitioner for 
advanced problems. Data are collected on thirty-five variables for each patient and entered 
into a computerized data base. Patients referred out for care are given an extensive referral 
packet and a list of physicians who have agreed to see clinic patients for a "consultation 
visit." The physicians have agreed to see these clients for a preset consultation fee but 
treatment costs are not discounted. Each client referred to private medical care is followed 
until treatment is completed or for a minimum of four months. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? A leadership role of the health department already existed in the community. The 
family planning program was able to plan and design a colposcopy clinic with the sanction of the 
medical community because the nurse practitioners and family planning staff over time developed a 
strong collaborative relationship with the local physicians. These nurse practitioners were among the 
first to be trained in Region X to perform colposcopy and biopsy, thus their leadership for the region 
was established. A Title X, Family Planning National Priority Project was written and accepted. The 
first colposcopy clinic was established. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. Locally, collaboration between the public and private health care systems has been 
enhanced because of the referral system and consultation clinics used by the colposcopy clinic. The 
health department's family planning program has gained recognition nationally for establishing a 
colposcopy clinic. This recognition is verified by the fact that all state family planning administrators 
have requested the manual written by a practitioner that outlines the steps in establishing a 
colposcopy clinic. 



48 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Lacl< of start-up funds. 

How overcome? A grant was written and 
funded by a Title X National Priority Grant and 
sponsored by USPHS Region X Family Planning. 



Barrier 2: Helping patients to bridge the gap 
between the health department and getting 
treatment at private physicians' offices. 

How overcome? The use of "consultation visit." 
Patients referred out for care are seen by physicians 
who through previous arranged agreement will see 
these clients at lower office cost. This visit is a 
brief, no-exam visit where all paperwork is reviewed 
and the patient receives recommendations for 
treatment and cost estimates for treatment options. 
This consultation visit helps to overcome 2 major 
barriers for the patient, fear of how much the visit 
will cost and fear of going to a private medical 
office and not knowing what will be done to them. 



5. How is it funded? Other: Title X, Family Planning National Priority Project. 
What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? In 

order to fulfill its goal of prevention of cervical cancer, the colposcopy project must fulfill two 
objectives: 1) provision of high quality colposcopy services; 2) facilitating treatment of any disease 
found. Thirty-six variables for each patient are collected and entered into a computerized data base. 
This information is analyzed by Epi Info. The compliance rate of patients referred for treatment is 
88%. Sixty-eight (68%) of patients biopsied were diagnosed with dysplasia. Only one patient with 
severe cervical disease has been lost to follow-up. Studies of comparable populations document 
compliance rates of 68-86%. 

6b. Has this initiative been formally evaluated? Yes. 

7a. Do you think that this initiative would work if implemented in another urban community? 

The colposcopy project model lends itself to use in other communities. 

Why? It enhances public and private cooperation and benefits both sectors. Easily duplicated forms, 
protocols, a standardized data management system, and referral system will make it possible to 
provide colposcopy services in many different settings. 



7b. Has this program been replicated elsewhere? No. 
If yes, where? 



49 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent Initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Travis County Health Department 
Austin, TX 



CityMatCH CONTACT: 
TELEPHONE: 



Donna Bacchi, MD, MPH 
512/476-0020 



CONTACT FOR MORE INFORMATION: 



1a. Initiative Name: Thurmond Heights Wellness Center 

lb. Categoryiies) that best applies to your initiative: 

Improving Access to Care - 34 Case management/care coordination 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 

Child Health - 12 EPSDT/screenings; 10 Immunization 

Other Outreach - 22 Communicable diseases: STD, HIV/AIDS, TB, HepB 

Women's Health - 02 Family planning 

Prenatal Health - 04 Prenatal care 



Describe the initiative. The Thurmond Heights Wellness Center provides preventive health care, 
case management, health education, and coalition building in an underserved community in 
North Austin. The Wellness Center team is staffed by one full-time R.N., two full-time 
community outreach workers, and two full-time VISTA volunteers. The project is managed by a 
community outreach coordinator with a medical doctor as a medical consultant. 

The Wellness Center is located at Thurmond Heights, an Austin Housing Authority (AHA) 
development. A small office facility is provided by the AHA for health services on an 
appointment and walk-in basis. The staff provides well child EPSDT screening, immunizations, 
TB testing, family planning, pregnancy testing, prenatal education, STD screening, counseling 
and referral to appropriate health and social services providers. The staff hopes to alleviate 
congestion at emergency treatment centers by having a nurse available to examine minor 
complaints free of charge. EPSDT screenings and immunizations are offered at two other AHA 
sites in the area, Northgate and Georgian Manor on one day a week. Thurmond Heights will be 
one of the sites for the Austin Health and Human Services Targeted Case Management Program 
for high risk women and children. Coalition building is accomplished through the Thurmond 
Heights Community Health Advisory Coalition. The Coalition meets on a monthly basis. 
Members include housing neighborhoods service providers and community members. 

The Wellness Center provides education programs to the community through schools, churches, 
AHA learning centers, and other community groups. Programs are presented by Wellness Center 
staff as well as volunteers from public health education groups such as the American Cancer 
Society, schools such as the University of Texas School of Nursing, and community members. 



50 



3a. In planning and Implementing this activity, what has been the leadership role of your health 
department? The health department wrote the proposal, hired the staff, monitors 
implementation of activities, and evaluates project. The health department staff delivers the 
project services. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Yes, the Austin-Travis County Citizens Health Care Network has recognized this project 
as "outstanding." 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Staffing core groups need an 
administrative associate or health educator. 

How overcome? Two VISTA volunteers joined 
the core ground. They assist with 
administrative duties. Health education is 
coordinated with other agencies, but would like 
to hire a fulltime educator. 



Barrier 2: Funding - Length of fund was 18 
months. The last 12 months are funded at 50% 
of original amount. 

How overcome? Effective October 1 , 1 994 the 
City of Austin general funds will fund the two 
community workers positions. The department 
will research for funds to fund the entire project 
since project is funded thru August 31, 1995. 



5. How is it funded? City/County/Local government funds; MCH block grant; Third party 
reimbursement (Medicaid insurance). 

What is the approximate annual budget for this initiative? $90,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? Yes, project 
has measurable process objectives, data is collected via monthly reports, AISD Immunization 
computer print-out, and a pre- and post-survey of residents, some of the outcome measures 
cannot be achieved within the time frame of grant. Therefore, activities are aimed towards 
process and impact. 



6b. Has this initiative been formally evaluated? 



7a. Do you think that this initiative would work if implemented in another urban community? Yes 

Why? Because this type of project is responsive to the needs of the residents user friendly, and 
delivered at a unique site: manager's office at a public housing development. Staff link clients to 
services that foster continuity of care, coordination of services maximizes community resources, 
project involves the community in all program aspects, and it's community-based. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



51 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's nnost successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Baltimore City Health Department 
Baltimore, MD 

Nira Bonner, MD, MPH 
410/396-1834 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Baltimore City Integrated Action Plan for the Prevention of Youth Violence 

lb. Category(ies) that best applies to your initiative: 

Adolescent Health - 1 9 Violence prevention/youth-at-risk 



2. Describe the initiative. The Baltimore City Health Department hosted a two-day citywide 
Summit/Retreat this Spring to address the problems of youth violence and prevention. 
Participants were invited from the community, the Department of Parks and Recreation, the 
Johns Hopkins Medical Institutions, and other pertinent agencies and organizations. Three 
focus groups were established, followed by nominal groups which produced a series of 
recommendations. These recommendations have been sent to the Mayor for citywide 
implementation. They call for establishment of new programs by several city and other 
agencies, with some projects to be jointly managed. The projects include the establishment 
of Rites of Passage programs, new values clarification school curricula, Family Support 
Centers, consortia of local community adult and youth leaders, mentoring programs, 
apprenticeship programs, business "adopt and invest" programs, expanded after-school 
programs, a program for innovative enforcement of truancy and curfew laws. 

An Office of Youth Violence Prevention is being established in the Department's Division of 
Child, Adolescent, and Family Health. This new office will in turn establish a citywide 
interagency Council on Youth Violence Prevention comprised of representatives of all city 
agencies involved in such activities. It is understood that the complex and intractable 
problems of violence can only be addressed effectively by using an integrated approach 
which brings to bear the resources of several agencies in a coordinated manner. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The initiative for developing innovative programs in the Baltimore City 
Government has come chiefly from the Health Department. It has acted as the convener, 
and the repository of staff support for recent violence prevention activities. It sees its role 
as principle facilitator rather than exclusive implementor of programs. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? People in other city agencies and in nonprofit health and social service agencies 
have been looking increasingly to the Health Department for guidance and information 
about new program initiatives on violence prevention. The Department's central mission to 
prevent disease, injury, and disability make it a natural focus for such new program 
development. 



52 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Developing a coherent set of 
recommendations from the many suggestions 
provided by the three diverse nominal groups. 

How overcome? A small workshop met 
consistently every two weeks over several 
months to hammer out a draft of the 
recommendations based on public health 
principles and practical approaches to 
implementation. 



Barrier 2: Obtaining cooperation from diverse 
agencies in and out of city government to 
work jointly on violence prevention projects of 
common concern. 

How overcome? By enlisting the support of 
the Mayor, it is hoped that all agencies will be 
encouraged to participate and own the 
program. 



5. 


How is it funded? Pending. 










What is the approximate annual budget for this 


initiative? 


$50,000 for a 


Director of Youth 




Violence Prevention. 









6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 

* Articulating the vision of public health response to youth violence. 

* Convening the first interagency, multi-disciplinary summit/retreat to draft consensus 
recommendations. 

* Creating an infrastructure to carry out an action plan. Specific data elements and the 
evaluation have not yet been developed. 

6b. Has this initiative been formally evaluated? N/A 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? By involving the community and leadership at every level, and by using integrated, 
preventive approaches. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



53 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



City of Berkeley 
Berkeley, CA 

Karen Furst 
510/644-7744 



CONTACT FOR MORE INFORMATION: 



1a. Initiative Name: Berkeley High School Center 

lb. Category(ies) that best apply to your initiative: 
Women's Health - 02 Family planning 

Adolescent Health - 18 School-linked/school-based services; 20 Teen pregnancy; 21 Teen 
parenting 
Prenatal Health - 06 Home visiting 



2. Describe the initiative. The Berkeley High School Health Center (BHSHC) is administered by 
the City of Berkeley Department of Health and Human Services, in partnership with the 
Berkeley Unified School District. The Health Center is located on the campus of Berkeley 
High School. The services provided at the Health Center include medical, mental health, 
health education, and social services. The aim is to provide comprehensive services, which 
are easily accessible to the students, and well coordinated. Reproductive health services ar 
a good example of this approach. To address the multifaceted aspects of this issue, 
services are provided in prevention, education, medical diagnosis and treatment, and 
psychosocial support. 

The Peer Health Education Program focuses in empowering youth with decision skills and 
positive personal responsibility attitudes. The Peer Educators are trained to educate other 
students in the high school and in the junior high schools about sexually transmitted 
diseases, teen pregnancy, and family planning. They also provide information about the 
services available at the BHSHC. Hearing about the Health Center from their peers helps 
students be more comfortable to come in for services. 

The Expanded Teen Counseling Program provides one-on-one counseling on pregnancy 
prevention and STD/AIDS prevention. Students receive guidance in choosing a 
contraceptive method, and over the counter contraceptives are provided for students 
requesting prescription contraceptives, or screening on-site. Per California law, students 
receive sensitive services without the need of parental consent. Also available are 
confidential HIV testing and counseling, and pregnancy testing and counseling. Pregnant 
teens are referred to the Public Health Nurse for case management, prenatal care follow up, 
and referrals as needed. 

All students using the Health Center are given a psychosocial screening. So students there 
for other services, such as general primary care, who are at risk for STD or pregnancy 
would be identified and referred for appropriate counseling, and family planning services if 
desired. Mental health services are available for students who are identified as needing 
assistance dealing with issues around sexuality, or relationships. 



54 



3a. In planning and Implementing this activity, what has been the leadership role of your health 
department? The City's MCH Director oversees the BHSHC and provides medical direction 
for the clinic; the City's Department of Health and Human Services funds the Health Center 
Coordinator and medical staff, provides the Family planning Clinic and counseling services, 
provides Mental Health Interns, and the Public Health Nurse case manager for the pregnant 
teens. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? There are many youth initiatives in Berkeley, and the BHSHC has helped the City 
take a lead in having adolescent health included as an important issue to be addressed. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Funding 

How overcome? The BHSHC Community 
Advisory Board petitioned the Berkeley City 
council for extra funds; the BHSHC 
Coordinator writes numerous grant 
applications. 



Barrier 2: Coordination among the various 
programs. 

How overcome? The BHSHC Coordinator 
meets regularly with all of the programs and 
staff to work out problems and coordinate 
services. 



5. How is It funded? City/County/Local government funds; General state funds; Private 
source(s): California Wellness Foundation. 

What is the approximate annual budget for this initiative? $530,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What are the major accomplishments to date? Data is 
collected at the time of service delivery and is computerized for ease of evaluation; about 
230 students were seen for family planning clinic and counseling services last year. 



6b. Has this initiative been formally evaluated? Yes 



7a. Do you think that this initiative would work if implemented in another urban community? 

Why? Being able to offer confidential Family Planning services to adolescents without 
parental consent would be very difficult in many communities. 



7b. Has this program been replicated elsewhere? 



55 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Jefferson County Department of Health 
Birmingham, AL 



CityMatCH CONTACT: 
TELEPHONE: 



Tracy Hudgins 
205/930-1560 



CONTACT FOR MORE INFORMATION: 



la. initiative Name: Immunization Delinquent Children Tracking System 

lb. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 

Improving Access to Care - 32 Other outreach activities 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships; 43 
Immunization tracking, recall systems 



2. Describe the initiative. An on-line computerized immunization data base system was developed by the 

Jefferson County Department of Health in 1988. Since its inception, the immunization system has evolved into an 
electronic tracking system for immunization delinquent children in addition to providing an up-to-date immunization 
history on each child seen through the Department's seven health centers and nine Healthy Start sites. 
Immunization information sharing has now expanded to The Children's Hospital through computer linkage with the 
Department's data base. The Children's Hospital provides specialty services, emergency and some acute care 
services for children served by the Jefferson County Department of Health and access to immunization history will 
facilitate care and decrease missed opportunities for immunization. 

Utilizing the immunization history data base, an electronic tracking system was developed which targets children 
2 years of age and less who are delinquent for at least 1 immunization. DTP, OPV, HIB & MMR status is 
evaluated. Hepatitis B has not been included in determining delinquent status at this time. Immunization 
Delinquent Children (IDC) forms used in tracking and documentation of follow-up and patient specific notification 
mailers are electronically printed for all delinquent children in the target group. Once delinquent status is verified, 
patient mailers requesting the parent to bring the child in for needed immunizations is sent. Telephone follow-up is 
routine and if indicated, a home visit is scheduled for patients who do not come Into siies for immunization. 

Coordination of immunization data Input has been developed between health center primary care providers, WIC 
and Healthy Start staff to improve the data base, decrease missed opportunities for immunization and increase 
referrals for immunization. 

The Jefferson County Department of Health routinely provides approximately 1 10,000 child health visits per 
year. A February 1994 CDC random audit of methods used to increase vaccine coverage and evaluate current 
status in achieving a 90% Immunization level for children less than 2 years of age by 1996 revealed a 94% 
compliance level of Department patients In this age group. Retrospective data from a random sample from 1988 
revealed an immunization completion rate of 60%. We feel that outreach activities, extramural clinics, focus on 
missed opportunities and use of the IDC Tracking System can be credited with the excellent immunization 
compliance rates of children served through the Jefferson County Department of Health. 



3a. In planning and implementing this activity, what has been the leadership role of your health department? 

Understanding that immunization is a fundamental prevention service that can markedly affect morbidity in the 
community, the Jefferson County Department of Health initiated the computerized system to Improve tracking of 
immunization delinquent children and to develop a data base for immunizations. A computerized system was 
deemed necessary due to the large numbers of children in Jefferson County who rely upon JCDH for 
Immunizations and the fact that these children access multiple health care sites within the county. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so. why? JCDH has 
been recognized for its efforts in achieving 90% immunization compliance by 1996 by the CDC. Development of 
an Immunization data sharing process with The Children's Hospital has enhanced cooperation between our two 
agencies and sets a precedent for future enhancement of the data base through other providers. 



56 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Ensuring the correct data input and correct 
status reporting into the system. 

How overcome? Training of all staff involved to include 
physician, nurses, clerical, WIC and data entry personnel 
was identified as the first step in establishing and 
maintaining a creditable data base. As the data base is 
dependent upon accurate documentation by medical staff 
of vaccines given at time of visit, accurate data entry of 
the vaccines given as well as accurate updating of past 
immunization history, staff cooperation and 
understanding of the system was essential to maintaining 
an accurate data base. Restructuring of the WIC on-line 
screen to allow for ease in identifying ICD has helped in 
increased history data input by WIC as well as increasing 
immunization referrals. Ongoing training programs and 
monitoring of the data for accuracy are assisting in 
maintaining the integrity of the system. 



Barrier 2: Allotting time and staff to do adequate IDC 
follow-up. Due to number of children seen and the 
transient nature of the population, having staff available to 
track and counsel patients regarding the importance of 
immunizations was difficult at the health center level. 

How overcome? Education of all staff regarding the 
importance of immunization and emphasis on decreasing 
missed opportunities has been essential. In addition, 
physician and nursing staff education regarding true 
contraindications has helped by decreasing missed 
opportunities. Public Health representatives located at 
each health center have been assigned to assist with IDC 
follow-up. Assistance from Healthy Start outreach 
workers and Disease Control personnel for tracking and 
education has been helpful. Incorporation of WIC into 
obtaining history and implementing a referral process has 
helped to update the data base and decrease missed 
opportunities. Disease Control Bureau operates Tot Shot 
Clinics at Healthy Start sites which increases opportunity 
for immunizations. Immunization data from Healthy Start 
sites is entered into the data base. This coordinated 
multidisciplinary effort has decreased the number of 
children identified as truly delinquent as well as enhanced 
the Department's tracking ability. 



5. How is it funded? City /County/Local government funds. 
What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in monitoring the 
initiative? What have been its major accomplishments to date? The objective is to maintain a minimum of 90% 
immunization compliance rate for children followed by the Jefferson County Department of Health. Information 
regarding compliance rates is obtained through random audits and review of the IDC data. To date, the 
Department has achieved 94% immunization compliance rates with children 2 years of age and under and 97% in 
school age children. 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? Any health care provider who has on-line computer capability should be able to implement this initiative. 
7b. Has this program been replicated elsewhere? Not to our knowledge. 

If yes, where? 



57 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's nnost successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Central District Health Department 
Boise, ID 



CityMatCH CONTACT: 
TELEPHONE: 



Kathy Holley 
208/327-8580 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Central Idaho HIV/AIDS One-Stop Clinic 

lb. Category(ies) that best applies to your initiative: 

Other Outreach - 22 Communicable diseases: STD, HIV/AIDS, TB, HepB 
Improving Access to Care - 30 One-stop shopping, co-location of services; 34 Case 
management/care coordination 



2. Describe the initiative. In June, 1994 the Central Idaho HIV/AIDS Consortium in 

cooperation with the Central District Health Department opened Idaho's first community 
health clinic for persons living with HIV/AIDS. Clinic services are offered to residents in a 
10 county area in central and southwestern Idaho. The area includes Boise, as well as 
several rural, medically underserved counties. The clinic provides clients and their primary 
care providers the opportunity to consult with infectious disease specialists experienced in 
treating HIV. The clinic offers psychosocial support services, nutrition counseling, oral 
health evaluations, counseling and referral, and case management services to every client. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? In March, 1993, Central District Health Department convened the first ever 
community-based HIV/AIDS coalition. Sixty-five people representing a broad spectrum of 
agencies, community-based organizations, health professionals, and people living with 
HIV/AIDS attended. The Consortium identified three major goals based upon local needs. 
The priority goal was the establishment of a community "one-stop" health clinic for persons 
living with HIV/AIDS. CDHD has made a major commitment of staff and resources over the 
past year to support the Consortium and make that goal a reality. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? No. 



58 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Funding of the clinic and 
consortium. 

How overcome? A proposal to help 
supplement the consortium's activities was 
made in April 1993 to the Rural Health outreach 
Grant but was not funded. A proposal 
requesting funds to open a "one-stop shopping" 
clinic was submitted to the State of Idaho's 
Department of Health and Welfare, Division of 
Health in November, 1993. The request was for 
$40,000 to be funded in part by a portion of 
Idaho's Ryan White monies ($26,359) along 
with a supplemental amount of $13,641. The 
proposal was funded in March, 1994. The 
Consortium is in the process of looking at 
funding opportunities with local businesses and 
private foundations to support all clinic 
activities. 



Barrier 2: 

How overcome? 



5. 


How is it funded? City/County/Local government funds; Other Federal funds: Ryan White 




monies. 




What is the approximate annual budget for this initiative? $65,000 



6a. Does this MCH initiative have specific, measurable objectives? How Is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? Objectives : 
Establish a consultative HIV/AIDS clinic in Boise for individuals who are HIV positive or living 
with AIDS. Provide within the HIV/AIDS clinic a one-stop clinic able to refer individuals for 
health consultations, social work case management, and personal support services. Provide a 
clinic that can be used by physicians in rural and urban communities to observe and learn 
diagnosis and treatment plans for individuals with HIV and symptoms of AIDS. 

6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? This initiative provides a model of partnership based upon community sanction. It builds 
the confidence and capacity of local primary care providers to serve individuals who are HIV-i-. 
It transcends turf issues and builds upon professional expertise of a wide variety of disciplines. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



59 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Boston Dept of Health & Hospitals 
Boston, MA 



CityMatCH CONTACT: 
TELEPHONE: 



Lillian Shirley, RN, MPH 
617/534-5515 



CONTACT FOR MORE INFORMATION: Ellen Freedman, MPH (617/534-5197) 



la. Initiative Name: Window Falls Prevention Program - Kids Can't Fly 

1b. CategorY(ies) that best apply to your initiative: 
Child Health - 14 Injury (Including child abuse) 



2. Describe the initiative. The Kids Can't Fly initiative was developed by the Department of Health & Hospitals, 
Childhood Injury Prevention Program in response to a high incidence of children falling out of windows in Boston 
during the spring and summer of 1993. Eighteen children under age seven fell from windows between the months 
of June and December; three of these children died. 20-25 children typically fall from windows each year in 
Boston, but the higher concentration during the summer months focused the city's attention on the issue of child 
window falls. Kids Can't Fly is a campaign designed to conduct citywide outreach and education to promote 
awareness about the risk of children falling out of windows. The Window Falls Prevention program was 
established by the mayor of Boston during the summer of 1994 by city ordinance and is a collaborative effort to 
provide education, technical assistance and encourage the voluntary installation of window guards by property 
owners, public housing and homeowners. The program's goals are to: 1) Make safe window guards available by 
reviewing window guard designs to meet the requirements of the Boston Fire Department and child safety and 
housing experts; 2) Implement distribution of window guards through a network of stores; 3) Design and distribute 
educational materials to parents and caregivers; 4) Develop and convey prevention messages to the media; 5) 
Provide follow-up to children who have fallen from windows; and 6) Establish a surveillance system to track 
window falls in Boston. Over the past two years Kids Can't Fly has distributed window guards, bilingual literature 
through a network of neighborhood health centers, family shelters and community agencies. Public and private 
property managers across the state have received information to distribute to tenants. Through private support a 
training video was locally filmed and produced on window falls prevention. A public service announcement (PSA) 
with singer Eric Clapton discussing window falls has been aired two years in a row on local television stations. In 
addition, television and radio PSA's have been developed by collaborating programs. 



3a. In planning and implementing this activity, what has been the leadership role of your health department? The 

Department of Health and Hospitals Childhood Injury Prevention Program (CIPP) identified the need for window 
falls prevention activities in 1992 through its work with the Pediatric Injury Prevention Task Force at Boston City 
Hospital. The Health department is recognized as taking the leadership role in this effort when the Massachusetts 
Office of Public Safety determined that they would not pursue window falls initiatives on the state level. The Dept 
of Health and Hospitals has played a key role in bringing together agencies and institutions throughout the city to 
establish a working group to advise and plan strategies and interventions. The Window Falls prevention program 
has been funded by the city and formally established within the health department. CIPP will oversee policies and 
procedures developed by the working group. CIPP is responsible for coordinating educational activities and the 
development of language appropriate materials and acts as the liaison between manufacturers, regulatory agencies 
and retailers with regard to window guards. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, why? The leadership 
of the health department has been enhanced as a result of the name recognition of the Kids Can't Fly Campaign 
and the linkages made with agencies throughout the city. Public hearing and press conferences have been well 
covered in the media and supported by the community. The program is accessible to the public via a well 
publicized phone number to answer questions, provide technical assistance and attend community meetings and 
events. The health department has been featured by a national news magazine program as an innovative solution 
and the department's efforts have been presented at the National Conference of Mayors by the Mayor of Boston. 



60 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Finding a window guard product that meets 
requirements for all regulatory agencies and involved 
parties. 

How overcome? The fixed window guards which were 
used initially in Boston and are used in New York City 
were considered barrier to exiting a residence in the case 
of emergency. To gain approval by the Boston Rre Dept 
we are now examining Operable window guards and are 
in the process of developing specifications, test protocol 
and overseeing the manufacturing and distribution of 
these window guards in Boston. 



Barrier 2: Passing a city ordinance to require the 
installation of window guards by property owners 
/managers in all residences where children age six and 
under reside. 

How overcome? The major opposition to the legislation 
was City Inspectional Services who did not want to be 
responsible for enforcing this regulation and the real 
estate/rental association who did not want property 
owners/managers to be required to install window guards. 
Both parties opposing mandatory installation suggested an 
aggressive educational campaign coupled with voluntary 
installation. There is a great deal of participation and 
support by the Rental Housing Association and voluntary 
installation is being done by the Boston Housing Authority 
and some independent property management companies. 



5. How is it funded? City /County /Local government funds. 

What is the approximate annual budget for this initiative? $69,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in monitoring the 
initiative? What are the major accomplishments to date? Our measurable objectives include the voluntary 
installation of window guards by 30% in homes with children age six and under in the City of Boston. Data will be 
collected from the following: 1) Number of public housing units to receive window guards based on figures from 
Boston Housing Authority and Massachusetts Housing Finance Agency; 2) Number of window guards shipped by 
manufacturers to Boston retailers; 3) Random survey of property owners with regard to window guards 
installation; 4) A sample of retailers selling window guards; and 5) Number of window guards donated by 
charitable organizations, hospitals and city funds. In addition, we are setting up a monitoring mechanism through 
Boston hospitals to identify window falls admissions and make referrals to the program. The program will 
follow-up with a home visit, a review of child's medical record and will work with the property owner/manager to 
install window guards in the building. Our most significant accomplishment is the decrease in the number of 
window falls by 67% from the same period last year. This decrease can be attributed to increased public 
awareness and behavior changes such as opening windows from the top down, moving furniture and installing 
window guards. 

6b. Has this initiative been formally evaluated? Yes, Program currently being evaluated. 

7a. Do you think that this initiative would work if implemented in another urban community? The Boston initiative was 
modeled after the New York City Window Falls Prevention program which demonstrated an 86% decline in the 
number of falls over the fifteen years following the enactment of a law requiring window guards. 

Why? It has been shown that window guards are 90% effective in preventing window falls and any urban center 
which has identified window falls as a public health problem can see this effort duplicated. We also encourage 
programs to incorporate falls from porches, balconies and other heights where poor quality housing is a 
contributing to pediatric falls injuries. The work we have done in Boston with discovering an improved window 
guard design can certainly benefit efforts in other cities needing an operable guard for the purpose of emergency 
egress. We have been working with national retail chains who could establish partnerships in other cities with 
products and information from the Boston market. 

7b. Has this program been replicated elsewhere? Yes, Chicago, Los Angeles, Philadelphia and New Haven have 
contacted Kids Can't Fly to implement similar programs or aspects of this program. 



61 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Mecklenburg County Health Department 
Charlotte, NC 



CityMatCH CONTACT: 
TELEPHONE: 



Polly Baker, RN 
704/336-6431 



CONTACT FOR MORE INFORMATION: Margaret E. Davis, WIC Nutritionist 740/336-6464 



la. Initiative Name: Breastfeeding Peer Counselor Project 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 09 Breastfeeding/nutrition/WIC 
Improving Access to Care - 32 Other outreach activities 



Describe the initiative. Low income, minority and adolescent women who have successfully 
breastfed their own babies are recruited and trained to serve as breastfeeding counselors for 
their pregnant and breastfeeding peers. As we enter our third year of operation, we have trained 
21 women and currently employ ten of these women, including three with bilingual skills. The 
peer counselor's goals are to promote breastfeeding and to provide culturally relevant, easily 
accessible, accurate information and support for women who wish to breastfeed. Our Peer 
Counselors have become a permanent resource for their communities - serving as role models 
and being available to provide accurate information and mother-to-mother support. Their work 
includes: Telephone outreach to new mothers; home and hospital visits; leading bi-monthly 
support group meetings (Happy Baby Club); presenting breastfeeding classes in hospital and 
Health Dept. maternity clinics and at monthly childbirth preparation and parenting classes; 
special outreach project to Teen mothers at TAPS school; participating in continuing education 
for themselves at conferences, workshops and staff meetings. The Breastfeeding Warm Line - a 
voice mail link to the community - is another service associated with the Peer Counselors. Their 
home telephone numbers are recorded on the Warm Line, and is available 365 days a year 
because of their dedication and willingness to help their peers. 

The project has been made possible through a coalition effort involving Health Dept., 
La Leche League and Carolina Medical Center. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Our Health department initiated the coalition and facilitated planning meetings 
which led to the establishment of the program. Health Dept. /WIC staff wrote the original grants 
to fund start up. WIC provides a nutritionist to coordinate the program and the H.D. is the 
"home" base, providing access to clerical support and office equipment. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Yes. The breastfeeding Peer Counselor Program is a new, cost-effective resource created 
by and for our community through efforts initiated by the health department. We are now 
recognized as a leader in our community in the field of breastfeeding promotion, education and 
support. We are also seen as a resource on matters concerning peer-based services. 



62 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Insufficient funds to establish and 
operate program. 

How overcome? Wide, ongoing search for 
funds from private grant agencies, donations 
and fund raising events. 



Barrier 2: Quality control - Challenge of 
providing appropriate training and support for 
counselors to enable them to be a source of 
accurate information and referral for clients. 

How overcome? Collaboration with agencies and 
organizations with experience and knowledge 
about breastfeeding and peer support - especially 
La Leche League and Chicago Breastfeeding Task 
Force; comprehensive training program; 
Documentation of all client contacts; Regular 
monitoring of records; Monthly staff meetings; 
Mentors for Peer Counselors; Developed referral 
system of Peer Counselors and H.D./CMC staff; 
Provide Community Resource list. 



How is it funded? Other Federal funds: WIC, March of Dimes; Private sources: Healthy Start 
Foundation for Carolines, CMC Volunteer; Private donations; Fund raisers-grocery store 
reimbursement, walkathons; sale of buttons, t-shirts. 



What is the approximate annual budget for this initiative? 
94/95: $30,000. 



92/93: $22,000; 93/94: $41,500; 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? Initiation 
rates up 1 1-2? Objectives: 1) To increase the incidence and duration of breastfeeding among 
WIC mothers, 2) To contact new breastfeeding mothers within 48 hours of the birth, 3) To 
provide ongoing follow up to mothers for as long as they choose to breastfeed. A tracking 
system was developed using log/encounter forms and our computerized patient care 
management system. Health Department staff, including Peer Counselors, generate an 
encounter form for each client served. Breastfeeding women and infants are identified by 
specific codes and information regarding initiation and duration are generated by state WIC 
office quarterly. A time/log form was devised for bi-monthly report of individual Peer Counselor 
activity. This data is tabulated and reviewed with Peer Counselors monthly. 



6b. Has this initiative been formally evaluated? Yes 



7a. Do you think that this initiative would work if implemented in another urban 
community? Yes 

Why? Mothers want what is best for their children. Breastfeeding is unquestionably babies best 
start. With accessible and culturally relevant information available from an experienced, 
educated peer, many more women can be assisted to successfully breastfeed their infants. This 
will improve the health of our nation, reduce costs, strengthen family bonds, and empower 
women. Everyone benefits. 

7b. Has this program been replicated elsewhere? No, not exactly. Only program we know of that 
successfully combines the efforts of health department. La Leche League and hospital staff. 



If yes, where? 



63 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Chicago Department of Health 
Chicago, IL 

Shirley Fleming 
312/747-9815 



CONTACT FOR MORE INFORMATION: Ed Mihaiek (312/746-5380) 



la. Initiative Name: Community Health Immunization Program (CHIP) 

1b. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 



2. Describe the initiative. Children residing in public housing in Chicago are at greater risk for 
low vaccine coverage than their counterparts living outside that environment. The CHIP 
was designed to canvass an entire housing development to identify children behind in their 
immunizations and immunize them in their apartment. 

Community volunteers were recruited to be trained as peer advocates of immunizations. 
Teams were formed consisting of a nurse, a health educator, and a community volunteer to 
go door-to-door and immunize delinquent children. When immunizations were not 
indicated, immunization records were collected and entered into the city's computerized 
Chicago Housing Authority (CHA) immunization tracking system. This system is capable of 
forecasting immunizations and generating lists of children in need of their next shots. 
Reminder letters can also be printed as an additional tool to keep children on track. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The success of the CHIP is directly related to the linkages established with 
several community agencies serving the residents of the targeted housing development. 
Volunteers were provided by the Wells Community Initiative, a community organization that 
works within the neighborhood sponsoring a number of service related activities. The Local 
Advisory Council (LAC) of the development was instrumental in the planning and 
implementation of the CHIP. They were also a major factor in helping gain the trust of the 
residents. The Chicago Department of Health (CDOH) assumed the leadership role in this 
entire activity. This innovative approach to elevate vaccine coverage in this population was 
a total community effort. However, the CDOH was viewed by all participants as the lead 
agency. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The aggressive approach to this significant public health problem demonstrated 
to the community that the CDOH was committed to listen to community leaders and 
involve them in finding solutions. This fact alone certainly enhanced the leadership 
standing of the CDOH in the community. 



64 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Security. 

How overcome? Communication was 
established early in the planning stages with 
the Chicago Police and CHA Police. Each day 
teams would be assigned to a certain area 
with a police escort. Itineraries were filed 
each day and visits were made between 
1 0am and 2pm, times that are considered to 
be the safest. 



Barrier 2: Community Acceptance. 

How overcome? Residents and community 
leaders were Involved from the beginning In 
the planning of CHIP. Their Input was 
Invaluable In formulating the final strategy to 
provide immunization services to the children. 
CHIP was perceived as a community function 
rather than a CDOH project. 



5. How is It funded? City/County/Local government funds; Other Federal funds. 
What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Through the CHA computerized tracking system, vaccine coverage can be measured. The 
CDOH is still In the process of establishing a baseline so that the Impact of this intervention 
can eventually be measured. 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? 

This initiative Is exportable to another urban community. 

Why? With proper planning and community input and support, the CDOH has 
demonstrated that a door-to-door Immunization campaign can be effective. 

7b. Has this program been replicated elsewhere? 

If yes, where? 



65 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: El Paso County Department of Health & Environment 
CITY/STATE: Colorado Springs, CO 

CityMatCH CONTACT: Betty B. McClain, RN, MSN 
TELEPHONE: 719/578-3258 

CONTACT FOR MORE INFORMATION: Diana Howell (719/578-3257) 



la. Initiative Name: Day Care Consultant Program 

lb. Category(ies) that best applies to your initiative: 
Child Health - 13 Expanded child health services 
Improving Access to Care - 26 Expanding private sector linkages 



Describe the initiative. Children in day care centers are at very high risk for illnesses, 
accidents and abuse. To address these risks, a day care consultant program was 
developed. The program provides a public health nurse to consult with a specific child care 
center as negotiated and contracted. The nurse visits the facility as specified in the 
contract on a regular basis. She is available to confer on individual or site concerns. The 
nurse will review records, policies, etc. and coordinates health services. She answers 
specific questions about communicable disease, growth and development, safety, 
immunizations and other relevant public health issues. The public health nurse also serves 
as an advocate for the child-care community. 

In addition, two workshops (Child Abuse in the Day-Care Setting and Health Practices in 
the Day-Care Home) taught by public health nurses were presented to the child-care 
providers. These classes are now being taught by a private agency with the Health 
Department in a consultant role. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Nursing Division at the Health Department was the leader in planning and 
implementing the day care consultant program. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. The Health Department's visibility within the community was increased. 
There is also a greater awareness within the private sector of the role and expertise of the 
Health Department. 



66 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Staff is reluctant to commit to 
program area because of need to work with a 
facility for an extended period of time. 

How overcome? Developed a process within 
the Nursing Division for staff to move in and 
out of programs when requested. 



Barrier 2: Lack of staff to expand program. 

How overcome? As new funding is available, 
the program is expanded as needed. 



5. How Is it funded? City/County/Local government funds; Contract. 

What Is the approximate annual budget for this initiative? 1 nurses work in the program 
for 22 facilities. Each nurse spends approximately 1-1 % hours monthly in this program. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Yes. Data is collected by each public health nurse and entered Into a data base by support 
staff. In addition, the Colorado Department of Public Health and Environment tracks the 
communicable disease data and the Department of Social Services tracks child abuse data. 

The demand for services has been greater than the Health Department can meet. There is 
increased awareness of identifying child abuse and reporting requirements for suspected 
child abuse. 

6b. Has this initiative been formally evaluated? No. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? With the growing demand for quality child care and the potential for child care to be 
a therapeutic component of services to at-risk children, providing a safe and consistent 
base for protection and prevention is a public health role. 

7b. Has this program been replicated elsewhere? Not aware of other Health Departments 
offering this program. 

If yes, where? 



67 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Columbus Health Department 
CITY/STATE: Columbus, OH 

CityMatCH CONTACT: Carolyn Slack 
TELEPHONE: 614/645-7473 

CONTACT FOR MORE INFORMATION: Donna Barnhart 



la. Initiative Name: GREAT START, (High Risk Infant Service Delivery Protocol) 

1b. Category(ies) that best applies to your initiative: 

Prenatal Health - 06 Home visiting; 07 Low birthweight/infant mortality 

Child Health - 1 1 Early intervention/zero to three; 14 Injury (including child abuse) 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. GREAT START, an infant mortality prevention project based in 
Columbus, Ohio, is a community collaborative effort between the local health department, a 
major urban delivery hospital and the local child protective services. The protocol begins 
with uniform risk assessment of all infants born at the delivery hospital, completed by labor 
and delivery and newborn nursery personnel. Depending on level of risk, assessed infants 
are referred to a child welfare worker and/or a public health nurse. From the point of 
referral, coordinated services between the two disciplines are delivered to the infant and 
his/her family for a minimum of seven months. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Columbus Health Department was instrumental in the developing of the 
protocol and the training of all necessary persons. Currently the Health Department's role 
is to coordinate the home visitation by the public health staff and to ensure communication 
between agencies. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? Collaborative efforts between the agencies have increased our knowledge of the 
community and strengthened our ability to work collaboratively. 



68 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Coordinating services between 
three agencies with different missions and 
scope of services. 

How overcome? Staff at all levels, from 
management to field staff, were involved in 
designing the protocol, creating the 
evaluation tools, and the day to day 
implementation. Focus groups consisting of 
members of all three agencies met throughout 
all steps of planning and implementation. 



Barrier 2: Creating the evaluation component. 

How overcome? A team of staff from the 
three agencies and a Professor of Social Work 
from Ohio State University developed, tested 
and are currently using "Goal Attainment 
Scales" that measure various aspects of an 
infant's health and a caretaker's parenting 
abilities. They are being utilized as a pre-test, 
post-test instrument which should measure the 
effectiveness of the services delivered to the 
infants and their families. 



City/County/Local government; Third party reimbursement (Medicaid, 



5. 



How is it funded? 
insurance) 



What is the approximate annual budget for this initiative? Unkown. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? The 
objectives of GREAT START focus on improving or maintaining an infant's health and a 
caretaker's parenting abilities. Specific areas include: medical care follow-up, feeding 
practices, growth and development, day-to-day functioning, caretakers responses to the 
infant, service linkage and mother's reproductive health. Data is collected utilizing "Goal 
Attainment Scales" developed specifically for GREAT START. It is still too early in the 
project to cite any notable accomplishments based on the data collected. 

6b. Has this initiative been formally evaluated? Yes, in process 

7a. Do you think that this initiative would work if implemented in another urban community? 
This initiative could be implemented in other communities. 

Why? It is a very similar initiative to the Healthy Start program in Hawaii where it has 
found considerable success. It requires commitment and dedication to reducing rates of 
infant mortality and child maltreatment in the community. 



7b. Has this program been replicated elsewhere? Yes. 
If yes, where? Hawaii 



69 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



City of Dallas Health Department 
Dallas, TX 



CityMatCH CONTACT: 
TELEPHONE: 



Alice Pita, MD 
214/670-8266 



CONTACT FOR MORE INFORMATION: Joyce Hopkins, R.N. 



la. Initiative Name: Health Education Literacy Partnership (H.E.L.P.) 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 06 Home visiting 

Child Health - 10 Immunization; 11 Early intervention/zero to three 
Improving Access to Care - 26 Expanding private sector linkages; 33 Increasing social 
support systems; 34 Case management/care coordination 



Describe the initiative. Being unable to read causes clients not to access health care much 
like a child fearful of going into a candy store because he/she has no pennies. The Health 
Education Literacy Partnership (HELP) takes three approaches to promote family literacy as 
an important aspect of wellness and as a means to improve access to health care for City 
of Dallas High Risk Case management clients. Community Service Aides (CSAs) encourage 
and train parents to celebrate their children's developmental milestones and to provide early 
language and emergent literacy stimulation. They also provide adult literacy and 
educational guidance to high risk mothers and their families. Multi-generational volunteers 
read to children in all Child Health Clinics both to enhance cognitive development and to 
role-model for parents so that they may see book sharing and story telling as a nurturing 
parenting tool. The third approach is directed to health care professionals to show 
literacy's role as part of routine health promotion teaching and developmental assessment. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The department exhibited its primary leadership role by insuring that literacy 
related activities were made available to our clients using existing and enhanced community 
resources. HELP also pioneered the use of reading and teaching parents appropriate 
developmental expectations to promote literacy as a way of life and as a means of 
increasing access to health care. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? By spotlighting reading in a clinic setting, the department focuses on literacy as a 
way for clients to increase their access to health care and to celebrate the developmental 
milestones of their children as a natural and nurturing parenting skill of which adult clients 
themselves may have been deprived. 



70 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Demonstrating to health care 
professionals that literacy is a health care 
access issue has been a particular challenge 
because the idea linking the two is a new one. 

How overcome? Overcoming the mindset that 
improving literacy is a low priority remains a 
continuing struggle. Showing CSAs and other 
providers how improved client literacy can make 
their efforts more effective has made them more 
receptive to placing literacy as a higher priority. 



Barrier 2: Encouraging school dropouts and self- 
perceived poor readers that they can make a 
difference in their children's lives as an 
offspring's first teacher is addressed from several 
directions. The rapidly growing number of these 
clients speaking only Spanish further has taxed 
health education efforts. 

How overcome? Department nurses and CSAs 
show clients how to share books that have 
pictures, magazines, family photo albums with 
children. They give clients books, and CSAs 
teach them things to do with their children which 
enhance cognitive development and emergent 
literacy. HELP parent education materials are 
being translated into Spanish and funding to buy 
children's books in that language is being sought. 



How is it funded? City/County/Local government funding; General state funds; SPRANS funds; 
Other Federal funds; and Private sources - Donations. 

What is the approximate annual budget for this initiative? $202,904.00 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? Four specific 
goals are attached. HELP uses a database to monitor trends which include emergency room and 
hospital admissions, immunization rates, education levels and clinic utilization. Major 
accomplishments : Waiting room readers in all child health clinics, the volunteer base broadened. 
Book donations, a grant proposal in progress and tentative continuing education programs for 
High Risk staff with the Dallas Public Library and the Dallas Public Schools, Three HELP 
sponsored Survival Skills by the Texas Department of Human Resources, A plan for bringing 
waiting room readers to Texas WIC clinics. Continued presentations on literacy as a way to 
better health. 

6b. Has this initiative been formally evaluated? Don't know. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? The concept can be as elaborate as funds allow using home visitors and clinic-based to 
teach parents how to encourage emergent literacy in their children, it can be accomplished at 
minimal cost if sufficient volunteer effort is used to read in waiting rooms, show parents by 
example how to read to children and conduct book drives. Parents can be signed up for library 
cards in clinics where residency already is verified. 

7b. Has this program been replicated elsewhere? Yes 

If yes, where? Boston City Hospital Reach and Read (ROR) program uses the waiting room 
reader and book giveaway components of HELP. 



71 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Combined Health District of Montgomery County 
Dayton, OH 

Frederick L. Steed 
513/225-4966 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: "Families in Fitness" - Intervention services for overweight adolescents 
and their families. 

lb. Category(ies) that best applies to your initiative: 
Child Health - 13 Expanded child health services 



Describe the initiative. Cardiovascular disease is the leading cause of death in the United 
States and in Montgomery County (FY 1992 data). Obesity is an independent risk factor in 
the occurrence of cardiovascular disease and is being seen with greater prevalence in the 
child and adolescent population. By intervening with adolescents who are obese, behaviors 
may be taught or corrected that reverse or decrease the risk for adult cardiovascular 
disease. 

The program offered by the Combined Health District is to teach and implement healthier 
eating and meal preparation, identification of the risk factors for cardiovascular disease and 
how to reduce them, and emphasize life-long family fitness through exercise and nutrition. 
The program is offered for ten weeks with a frequency of 3 sessions per week. The 
nutrition education segment consists of weekly focus topics presented in an interactive, 
hands on format with take home assignments to complete. Parents are required to attend 
these sessions. 

Exercise sessions are 30-35 minutes in length and promote sustained aerobic activity that 
is non-competitive and fun. Parents are encouraged but not required to attend. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Child & Family Health Services and the Adolescent Wellness Centers 
identify adolescents (9-14 years) that wish to participate in and are in need of overweight 
intervention. The YMCA provides the facilities for the program. This is an effective 
partnership because the YMCA is a long standing, well recognized organization concerned 
with promoting physical, emotional and spiritual well being for youth. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Uncertain at this time. 



72 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Overcoming parents' and patients' 
apathy about getting involved to take action. 

How overcome? Questionnaires were 
administered to find out parents' feelings 
about their child's weight and what they 
perceived were barriers to attending a 
program and making changes. 



Barrier 2: Offering the program at a time 
when the parent would participate with their 
children. 

How overcome? Early evening and weekend 
schedules to accommodate working families in 
an easily accessible facility. Providing 
personal incentives for attendance and 
program implementation. 



5. How is it funded? City/County/Local government funds; and MCH block grant funds. 
What Is the approximate annual budget for this initiative? $40,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? Pre- 
and post-program questionnaires to determine: 

1 ) Nutritional knowledge gained 

2) Cardiovascular risk factors knowledge gained 

3) Changes made in attitudes towards healthy lifestyle choices 

4) Participation in exercise sessions 

5) Monthly assessments of maintenance after the ten-week duration 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? This is addressing a national problem and attempts to meet national, i.e., Healthy 
People 2000 Objectives for nutrition and physical fitness. 



7b. Has this program been replicated elsewhere? No. 
If yes, where? 



73 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Denver Dept of Health & Hospitals 
Denver, CO 

Paul Melinkovich, MD 
303/436/7433 



CONTACT FOR MORE INFORMATION: Sharon Martin, RN 



la. Initiative Name: Denver Metro Infant Immunization Campaign 

1b. Category(ies) that best apply to your initiative: 
Child Health - 10 Immunization 



2. Describe the initiative. Developed Denver Metropolitan Immunization Outreach Campaign 
to provide free immunizations to children in the Metro area. The initiative targets 
communities with high concentrations of low-income children and serves children residing 
within the jurisdictions of the three major health departments in the Denver Metro area. 
The participating health departments are Denver, Tri-County (Aurora) and Jefferson 
(Lakewood). The initiative utilizes staff from all health departments and volunteers to 
provide immunizations. Assistance with media and promotions is provided by the local 
Rotary Clubs and the Statewide Immunizations Coalition. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Denver Department of Health and Hospitals provided the leadership to 
organize the initiative and pull together the other participants. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? Yes. Increased recognition of the leadership role of Denver in addressing 
immunization issues in Denver and the state. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Inability of local health 
departments to work together. 

How overcome? 1 ) Hard work at staff level 
to address details of initiative. 
2) Agreement to evaluate success of initiative 
after one year. 



Barrier 2: 

How overcome? 



5. How Is it funded? City/County/Local government funds; Other Federal funds. 
What is the approximate annual budget for this initiative? 



74 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? D 
Objectives are primarily related to Increasing number of children accessing Immunizations. 
Data on children served, residence, health insurance coverage. Immunizations status and 
reason for using clinics are currently being collected for analysis. Major accomplishment to 
date Is the provision of immunization services to 689 children In the Metro area during the 
first six months of the year. 

6b. Has this Initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? 

7b. Has this program been replicated elsewhere? No 



75 



1994 Urban MCH Leadership Conference Profile 



Describe your health departnnent's nnost successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Detroit Health Department 
Detroit, Ml 



CityMatCH CONTACT: 
TELEPHONE: 



Judith Harper West 
313/876-4228 



CONTACT FOR MORE INFORMATION: Yvonne C. Rush 



la. Initiative Name: Detroit Healthy Start Community Development Initiative 

lb. Category(ies) that best applies to your initiative: 

Prenatal Health - 07 Low birthweight/infant mortality 



Describe the initiative. The goal of the Detroit Healthy Start Project is to reduce infant 
mortality by 50% in the selected target area within the next five years. The Community 
Development Initiative is based on three themes: 

the community is a real partner in fostering change 

coordination of services begins at the point of the client 

access to care should be barrier free 

Eleven community organizations have been funded to provide outreach and "inreach" at 
existing agencies to identify clients who would benefit from the Healthy Start case 
management approach to prenatal and healthy infant care. This initiative is a crucial link in 
the development of coalitions of public and private agencies to address the problems of 
at-risk pregnant women and their families. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Detroit Health Department has coordinated the recruitment and selection 
process for community groups to participate in this initiative. One staff person monitors 
CDI performance and arranges support. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Assisting grass-roots community 
groups in administrative, fiscal and 
documentation procedures. 

How overcome? Quarterly inservice training 
sessions are held for CDI. 



Barrier 2: 



How overcome? 



76 



5. How is it funded? 

What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Yes. Data are collected through submission of annual reports submitted by the community 
groups. The data collection is the major accomplishment to date. 



6b. Has this initiative been formally evaluated? Yes. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Grass-roots community groups are able to locate hard-to-reach pregnant women and 
get them into care with greater success than are bureaucratic agencies. 



7b. Has this program been replicated elsewhere? Unknown. 
If yes, where? 



77 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT; 
CITY/STATE: 



Durham County Health Department 
Durham, NC 



CityMatCH CONTACT: 
TELEPHONE: 



Gayle B. Harris 
919/560-7700 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Saturday Maternity Clinic Services 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 04 Prenatal care 



2. Describe the initiative. The Durham County Health Department is the primary provider of 
Prenatal care for low income women in our community. Maternity Clinic services and 
Maternity Care coordination provided by the Health Department are housed at Lincoln 
Community Health Center, a federally funded community health center. Traditionally, 
services have been provided Monday-Friday, 8:30 a.m. to 5:00 p.m. each day except 
Tuesday when clinic hours are extended until 8:00 p.m. In an effort to improve clinic 
access, the Health Department contracted with the Health Center to provide maternity 
clinic services, maternity care coordination, childbirth classes, nutrition counseling/WIC 
services, laboratory services, and transportation on Saturday mornings from 8:30 a.m. to 
12:30 p.m. Direct patient services are provided by staff who meet the requirements 
specified in health department job descriptions. Since the Center has opened for maternity 
services, a limited number of pediatric services (i.e., immunizations, sick child care, etc) 
have been added on Saturday mornings at the Center's expense. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Health Department administration introduced this idea to the administrator of 
the Health Center. With her approval of the idea, the Health Department administration 
developed the plan, met with the finance officer of the Health Center to determine costs 
and the County Attorney to develop a comprehensive contract. The Health Center's 
Personnel Office then hired the necessary staff. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? This initiative is seen as further substantiation of the willingness of the leadership 
of the health department to work with other agencies to meet the needs of the patient 
population. 



78 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Identifying a mechanism for paying 
professional staff for working in the clinic 
since exempt county personnel could not be 
paid for working overtime. 

How overcome? The County Attorney 
assigned to the Health Department designed a 
contract that would allow the Health Center 
to employ the appropriate staff for the clinic. 



Barrier 2: 

How overcome? 



5. How is it funded? City/County/Local government funds; Third party reimbursement 
(Medicaid, Insurance) 



What is the approximate annual budget for this initiative? $62,500 



6a. Does this MOM initiative have specific, measurable objectives? How is data collected and 
used In monitoring the Initiative? What have been its major accomplishments to date? 
This initiative was introduced to reduce the broken appointment rate by improving clinic 
access. The number of scheduled appointments and the number of broken appointments 
are monitored. Patients who do not keep appointments are contacted either by telephone 
or home visit. If the patient delivered by the time the clinic appointment she is not counted 
in the number for broken appointments. Prior to the initiation of the Saturday morning 
clinic sessions, the overall broken appointment rate was 39%. Now it is 21 %, with the 
rate for Saturday morning clinic being 15%. 



6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? This initiative would work in another urban community. Collaboration and 
coordination would avoid duplication of effort while maximizing resources to meet the 
needs of our patient population. 



7b. Has this program been replicated elsewhere? No 
If yes, where? 



79 



1994 Urban MCH Leadership Conference Profile 



Describe your health departnnent's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



El Paso City-County Health and Environmental District 
El Paso, Texas 

Martha Ouiroga, MSN, CNO 
915/771-5748 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Schools and Health Connections 

1b. Category(ies) that best applies to your initiative: 

Improving Access to Care - 29 Schools and health connections 



Describe the initiative. During FY 93/94 the El Paso City-County Health & Environmental 
District was a participant in the collaborative efforts to both plan and develop health care 
services in connection with schools. By serving as a member of the advisory council to the 
Kellogg funded project and as a member of the planning committees for two other school 
districts it was possible to provide information and guidance needed to establish school- 
based or school-linked health services. 

The Health District has been an active member of the Kellogg Advisory Council since its 
inception. The Council had decided on four sites within the eastern boundaries of the 
county where health services have always been scarce. The development of the role of the 
Volunteer Community Health worker is now well known in these sites. This project's main 
purpose is the education of health professionals in sites which are school-based or school- 
linked; the multi-disciplinary team approach is also a primary focus at these sites. 

Through collaborative efforts the Health District has provided immunizations as a direct 
service and as a training incentive for new providers at these sites. Child health services 
and Adult Health Services were also provided. As the Kellogg obtained additional staff 
many services have been assumed by the project. This comes at a time when the 
resources of the Health District have been decreased. 

The Health District assisted two other independent school districts with the 
development of "Family Resource Centers." Linkages to the Texas Tech Regional 
Academic Health Center and the University of Texas at El Paso College of Nursing and 
Allied Health Sciences were established. Identification of funding through the Texas 
Department of Health was provided to both projects. In particular providing a constant 
linkage to the internal resources within the school districts such as the school nurses was 
imperative. Both systems have begun centers with multi-disciplinary services to include 
educational services for the community surrounding the sites. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The leadership role of the Health District has involved being supportive, 
informative, accessible, motivational, and resourceful. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The Health District has been identified as a community developer in the area of 
health care services for families with limited resources. 



80 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Each system has intentions of 
"doing its own thing." Since each community 
being serviced has its own individual 
characteristics, the particulars of how the 
centers are functioning depend heavily on 
assessment of needs for that area. Each 
committee preferred to keep information to 
itself. 

How overcome? Respect for each group 
was maintained. Responses to questions 
were provided in a timely manner as much as 
possible. Confidential information from one 
group was not shared with the other. 
However, now that a year has passed, the 
systems are visiting each other and sharing 
their own details by themselves. 



Barrier 2: 

How overcome? 



5. How is it funded? 

What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? No 



6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 

Why? The main reason that this initiative is presented is to point out that El Paso, a city 
which has been behind the times in this area of need, is finally joining the rest of the nation 
in the utilization of school-based health centers! We need to be congratulated in finally 
accomplishing this effort!!! 

7b. Has this program been replicated elsewhere? N/A 

If yes, where? 



81 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Tri-County Health Department 
Englewood, CO 

Maggie Gier, RNC. MS 
303/220-9200 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Mother's First 

1b. Category(ies) that best applies to your initiative: 

Prenatal Health - 08 Substance abuse prevention/treatment 



Describe the initiative. The Mother's First Program is designed to help prevent fetal 
damage and to improve family functioning in a targeted population of pregnant women who 
use alcohol or drugs, or who are experiencing significant psychosocial stress. 

The program provides on-site drug, alcohol and psychosocial assessment and counseling; 
home and clinic visits for support and teaching during the prenatal period and during the 
Infants' first year of life; and referral to appropriate community resources. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The program was conceived and developed by the community health nurses 
and the prenatal staff of this health department. They had recognized that there were an 
increasing number of women in the prenatal clinic with these needs which were not being 
addressed during routine prenatal visits. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? Because of this program the health department has been recognized as taking an 
important role in prevention of drug and alcohol related prenatal and post partum 
complications including pre-term labor and child neglect and abuse. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : The women identified as most 
likely to benefit from the program lack insight 
into the risks to the unborn and infants, and 
lack social skills to participate in therapeutic 
groups. 

How overcome? Most counseling needs to 
be one-on-one and done in a non-threatening 
environment like the client's own home or in 
a park. 



Barrier 2: Most clients are low income and 
don't have access to child care and 
transportation to keep appointments. 

How overcome? Collaboration with an 
addictions facility which had child care and 
bus tokens or taxi funds was most helpful for 
these clients. 



82 



5. How is it funded? Grant from Childrens Trust Fund and In-Kind. 

What is the approximate annual budget for this initiative? $33,518.59 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? 
Measurable objectives were developed by the program coordinator and the Trust Fund 
representative. Data reports are submitted to the Trust on a quarterly basis and compared 
to objectives. Six month and annual reports are prepared by the Trust. Regular therapeutic 
groups held in collaboration with a treatment facility where parenting and substance abuse 
are discussion topics. Pre-term labor, pre-term birth and low birthweight statistics for this 
high risk population which are equal or lower than like populations. 



6b. Has this initiative been formally evaluated? Yes. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? With like staffing and available funding this program would work well in any intercity 
environment with an at-risk population. 

7b. Has this program been replicated elsewhere? No, not to our knowledge. 

If yes, where? 



83 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's nnost successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Lane County Health Department 
Eugene, OR 



CityMatCH CONTACT: 
TELEPHONE: 



Jeannette Bobst 
503/687-4013 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Lane County Comprehensive Pregnancy Services (LCCPS) 

1b. Category(ies) that best applies to your initiative: 

Prenatal Health - 04 Prenatal care; 06 Home visiting; 07 Low birthweight/infant mortality 
Improving Access to Care - 26 Expanding private sector linkages; 35 Increasing access to 
Medicaid 



Describe the initiative. Lane County Comprehensive Pregnancy Services (LCCPS) is the joint 
effort of public, private and non-profit agencies working to provide access to early prenatal care. 
This effort includes intense, active communication between agencies, and the sharing of some 
of their specific services in providing prenatal care. The primary goals of the program (initiative) 
are to provide access to prenatal care for any pregnant woman, regardless of ability to pay; to 
provide low income women access to prenatal education classes; and to provide newborn 
follow-up for the women participating in the program. The Public Health Agency acts as the 
"gate keeper" for clients, using the Case Management model. This management model also 
provides referral services to other supportive agencies such as Women, Infants and Children 
(WIC), Oregon State Extension Services and other community social services. The primary 
agencies are: Lane County Public Health, Sacred Heart General Hospital (SHGH), private 
obstetrical care providers, and Oregon State Adult and Family Services (Medicaid program). This 
comprehensive program assures access to affordable, coordinated and high quality prenatal care. 
Each agency maintains its separate identity, budget and services. If any one agency withdrew 
from this program, the other agencies would continue to provide their individual services. The 
uniqueness of this program is the cooperative coordination of diverse agencies. Interagency 
contracts are not needed. This program was established in 1987 to address the problem of 
accessing the declining number of OB care providers, the high cost of prenatal care, and the 
significant number of pregnant women deliverying with inadequate or no prenatal care. This 
program continues today as it was designed seven years ago. 



3a. in planning and implementing this activity, what has been the leadership role of your health 
department? Public Health worked as co-chair with SHGH in scheduling and conducting the 
meetings that addressed the affordability and access problems for prenatal care in Lane County. 
The Lane County Health Officer met independently and individually with the delivering physicians 
to solicit their interest in working on these problems. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? I would say that our leadership role in the community was enhanced. We are able to 
bring to the table the county-wide picture of the problem, which many of the urban providers 
were not aware of. We were able to enlighten the providers in the long term value of Maternal 
Child Health home visits, as compared to providing vouchers as a short term solution. 



84 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Getting OB providers to attend the 
fact-finding meetings. 

How overcome? Several surveys were used in 
an attempt to find a common day and time for 
providers and community leaders to meet. 
County Health Officer met privately with the 
most senior OB providers in the community to 
get their input and concerns so that the 
meetings would have a good chance for 
success. Breakfast meetings being high on the 
list, SHGH provided the meeting place and the 
breakfast. 



Barrier 2: Care providers and community leaders 
lacking knowledge of the full scope of the 
problem pregnant women were having in 
accessing affordable prenatal care. 

How overcome? SHGH and Public Health 
gathered statistics and presented them in a 
graphic manner, so that everyone at the 
meetings clearly understood the scope of the 
problem and was willing to actively participate in 
developing a solution. 



5. How is it funded? 

What is the approximate annual budget for this initiative? 



6a. 



Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? The primary 
objective was to reduce the number of women delivering with inadequate or no prenatal care. 
This is monitored from data on the birth certificates. In 1987, the number of women delivering 
at Sacred Heart Hospital with inadequate care was 255, and by the end of 1991, it was 58. 



The second objective was to reduce the "write-off" costs of NICU use. A two year study of 
385 mother-infant pairs who received inadequate prenatal care prior to the LCCPS program had 
a total cost of $966,350 to the hospital. In 1991, for mother-infant pairs receiving adequate 
prenatal care, the cost to the hospital was $4,230. 



6b. Has this initiative been formally evaluated? Yes. 
University of Oregon. 



An evaluation was done by Dr. Sandy Harvey, 



7a. Do you think that this initiative would work if implemented in another urban community? I think 
this initiative would work in other urban communities. 

Why? Most communities as large or larger than the Eugene/Springfield metro area have all the 
major agencies of this collaboration program. We have received requests for information on this 
program from many other Oregon counties, from Billings, Montana and Vancouver, Washington. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? Deschutes County, Oregon has implemented a similar LCCPS in conjunction with 
St. Charles Hospital. 



85 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Vanderburgh County Health Department 
Evansville, IN 



CityMatCH CONTACT: 
TELEPHONE: 



Constance E. Block 
812/435-5766 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Vanderburgh County Child Health Clinics (MCH Program) 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 06 Home visiting 

Improving Access to Care - 34 Case management/care coordination 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. Increased grant for Health Department's 3 full-time Child Health 
Clinics and expanded cooperative arrangements. Goals: 1) Increase immunization rate : 
co-located WIC Clinics, assess immunizations and refer to Child Health Clinics. If in arrears 
or vy/ithout shot records, issue monthly food vouchers (instead of bi-monthly). 2) Increase 
Early Periodic Screening and Diagnostic Testing (EPSDT) : streamlined process; educated 
and trained staff. 3) Decrease premature deliveries and low birthweight infants and 
increase early prenatal care/care coordination : Began free pregnancy tests. Counsel and 
give help accessing medical care, Medicaid, and other resources. 4) Maintain and enhance 
collaborative affiliations : a) United Way's First Call for Help to route pregnancy and child 
health calls to the Health Department's new Resource and Referral line, b) Collaborative 
arrangements with physicians at 3 hospitals for 24-hour coverage for child Health Clinic 
clients. Clinics' nurse practitioners have telephone access to hospital physicians during the 
work day for consultation and referrals, c) Issue clothing coupons for Junior League's new 
store as incentives to complete immunizations by 15 months and promote breastfeeding, 
d) Formed a Maternal Child Health Community Board, a network to support comprehensive, 
community-based health care systems that work to identify and assure family centered, 
culturally-competent, coordinated services for women of reproductive age, infants, children 
and adolescents. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Health department staff members led in planning and implementing this 
activity. It became a collaborative community effort. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. We have made noticeable strides in networking related to maternal and 
child health in our community. Many needs have been identified. The Health Department 
has assumed a much more active role regarding community health. 



86 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Ponderous nature of bureaucratic 
government on local and state levels. 

How overcome? Kept trying! Tackled one 
point at a time and remained focused on the 
goal of improving services to pregnant 
women and to children. 



Barrier 2: 

How overcome? 



5. How is it funded? City/County/Local government funds; MCH block grant funds; Third 
party reimbursement (Medicaid, insurance). 

What Is the approximate annual budget for this initiative? $680,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? 
Yes. Data is collected on computer in the format required by the Indiana Maternal and 
Child Health and WIC Program. Additional material is tabulated locally. 

Statistics are reviewed monthly by the project coordinator and her two supervisors locally. 
The State Department of Health also reviews material. Final funding approval was received 
from the State Department of Health in late May, 1 994. New staff came on board in July, 
1994. No data available yet. 



6b. Has this initiative been formally evaluated? 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? People are willing to collaborate because the clients involved are mainly lower 
income and tend to have multiple pressing needs - which tax resources of all care 
providers. The Health Department provides the free outreach component into homes, the 
WIC Program and routine preventive child health services on a sliding fee scale basis; other 
entities offer their specific services in hospitals and offices around the city. 

7b. Has this program been replicated elsewhere? 

If yes, where? 



87 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Genesee County Health Department 

CITY/STATE: Flint, Ml 



CityMatCH CONTACT: 
TELEPHONE: 



Jenifer Murray, PN, MPH 
810/785-5263 



CONTACT FOR MORE INFORMATION: Carol Roberge (810/785-8530) 



la. Initiative Name: Community-Based Early Periodic Screening, Diagnosis & Treatment 
(EPSDT) Outreach 

lb. Category(ies) that best applies to your initiative: 
Child Health - 12 EPSDT/screenings 

Improving Access to Care - 24 Overcoming racial/ethnic/language/cultural barriers 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. Community-Based EPSDT Outreach is the coordinated-collaborative 
effort between the Genesee County Health Department and the following community-based 
organizations: Flint and Vicinity Action Community Economic Development (FACED) and 
Flint Neighborhood Improvement and Preservation Project (FNIPP) in conjunction with the 
Flint Neighborhood Coalition (FNC). In order to facilitate entry into the health care system, 
the community-based organizations' outreach staff contact potential clients in the 
community to encourage participation in the EPSDT screening program by enthusiastically 
emphasizing the uniqueness and the benefits of receiving an EPSDT comprehensive health 
screening. Client contacts are made by making personal contacts with eligible clients. 
Scheduling of appointments and arranging transportation is provided after establishing 
client eligibility and securing the client's interest in participation. By having 
community-based people promote the program and encourage participation, the client feels 
more comfortable in asking questions and enrolling in the program, therefore participation 
increases. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health Department took the initial leadership in developing 
relationships/partnerships in the EPSDT outreach program. Over time, the process has 
allowed the Health Department to take less leadership and the community-based 
organizations to take more leadership. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? By allowing the community to participate in promoting Health Department 
programs, the credibility of the Health Department has increased. Indirectly, leadership has 
increased. 



88 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : A confidential "listing of eliglbles" 
is the EPSDT outreach workers' crucial 
informational source of contacting eligible 
EPSDT Medicaid recipients for screening. 
Because the outreach workers are not Health 
Department employees, bureaucratic red tape 
prevented the outreach workers authorized 
access to this information. 

How overcome? The Genesee County Health 
Department developed a relationship at the 
State level Department of Social Services to 
allow access of outreach workers to the list 
of eligibles. 



Barrier 2: Managed Health Care (HMOs and 
PSPs) has brought its barriers for the client to 
receive needed preventive health screenings. 

How overcome? Currently, suggestions and 
discussions are taking place regarding 
collaboration with some HMOs; such as, 
letters of agreement to permit the GCHD 
EPSDT staff perform health screenings on their 
HMO Medicaid patients. Letters requesting 
consent for GCHD EPSDT staff to screen PSP 
patients are being sent to known local PSP 
physicians. Many PSP physicians have 
returned written consents for GCHD EPSDT 
staff to screen their Medicaid PSP patients. 



5. How is it funded? General state funds; Third party reimbursement. 
What is the approximate annual budget for this initiative? $391,997 



6a. Does this MOM initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Expected number of outreach services for FY 93-94: 
- 10,332 appointments to be scheduled (FNC: 7,266; GCHD: 3,056) 

480 screening appointments to be transported by FACED 

52.26% client show rate goal 

Expected number of clinic services for FY 93-94: 
6,000 screens 

Data is collected by computer by the program coordinator. 

6b. Has this initiative been formally evaluated? No. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes, this initiative could work in another urban community. 

Why? If the health department takes the time, develops a "community-based" mentality 
and genuinely wants to work with the community, this could work anywhere. It is real 
important to let all barriers down, keep an open mind, be willing to set up meetings in 
community-based settings and respect the differences community-based organizations may 
have from the health department. This needs to work in other urban areas so that the 
community is served in a manner that it wants to be served. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



89 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



City of Garland Health Department 
Garland, TX 



CityMatCH CONTACT: 
TELEPHONE: 



Grace Rutherford 
214/205-3460 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: TB Screening Program 

1b. Category(ies) that best applies to your initiative: 

Other Outreach - 22 Communicable diseases: STD, HIV/AIDS, TB, HepB 



2. Describe the initiative. Noting population increases in Hispanic and Asian races combined 
with poverty and language barriers as well as illegal immigrant status, we decided to screen 
children and their foreign-born parents who were in the high risk areas of the world 
specified by CDC (Asia, Africa, Latin America). The screening was provided free and 
automatically with the child's immunizations. Through this effort, 2 pockets of TB were 
uncovered and the local county health department (provides all TB for services for public 
health in the area) now comes to our city twice a month. They were also very supportive 
in tracking down positive reactors who failed to follow through for treatment. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? A the time, everyone else was cutting back on TB screening we were told it 
was not necessary. No other health department in our area combines immunizations with 
TB screening at shot clinics. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? It has increased our communication and improved our working relationship with 
our county health department. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Cost 

How overcome? A local women's league 
initially funded the program. When the 
county saw the results, they were willing to 
provide the testing again. 



Barrier 2: Follow-up 

How overcome? The amnesty laws and 
getting a Spanish speaking clerk helped patient 
cooperation. The school district also helped 
read student's tests. As active cases were 
found, the county got more involved in 
locating and assisting positive reactors to get 
to clinic for examination and treatment. 



90 



5. How is it funded? City/County/Local government funds; Private sources - Junior League. 
What Is the approximate annual budget for this initiative? $ 1 000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been, its major accomplishments to date? 
Number and age of clients tested, number and age of clients whose tests are read and the 
results are reported to the county. About 1 /3 receive medication for TB prevention. The 
county does not report to us # of active cases or # who complete treatment. 

Major accomplishments - 1 ) several active cases found and appropriate actions were taken 
to stop the spread of disease. 2) now a closer site is available to patients who require TB 
treatment. 



6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? TB testing is a simple procedure. It does require more time, but much of the 
explanation can be done by clerical personnel. It is a relatively inexpensive test (< 
$2/client). The readings of the tests are facilitated if community agencies pull together and 
the clinic is accessible (time and location). 



7b. Has this program been replicated elsewhere? Don't know. 
If yes, where? 



91 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Gary (Prec-lnct Clinic) 
Gary, IN 

Sharon Mitchell 
291/882-1113 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Co-Location of Community-Based Agencies with Healthy Start Program 

1b. Category(ies) that best apply to your initiative: 

Improving Access to Care - 30 One-stop shopping, co-location of services; 34 Case 

management/care coordination; 25 Reducing transportation barriers 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. The Health Department's most recent initiative in Maternal-Child 
Health involved the co-location of community-based agencies with the Healthy Start 
Program. The MCH clinic and The WIC clinic relocated to join the Healthy Start Program. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Gary Health Department submitted the grant proposal for the planning 
and implementation of the Healthy Start Program. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The leadership of the Health Department has been enhanced as a result of this 
activity. Since the initiative involved four neighboring cities, an inter-local health coalition 
emerged with the health commissioner of each city. Now, the coalition is at the forefront 
of all health related issues and grant proposals. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Territorial and different 
perspectives. 

How overcome? Keeping focus, open 
mindness, and city planning committees for 
individualized needs of the community. 



Barrier 2: Territorial Issues: Being a primary 
care provider on site for prenatal care. 

How overcome? Because local primary care 
providers were participating in the referrals for 
prenatal and pediatric care, a rotating provider 
schedule was implemented. Also meetings 
were held to discuss the MCH Clinic services 
as related to prenatal and well-child care. 



92 



5. How is it funded? Other Federal funds. 

What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? D The 
objectives of the partnership are to create "One Stop Shopping" and decrease the number 
of barriers to health care. Monthly stats are collected for the number of referrals to and 
from each agency. 

The major accomplishments to date are enhancement and coordination of services. Each 
agency enhances the service of one another. For example, a pregnant woman in for clinic 
visit (MCH) can have transportation to the clinic and have tot-drop services (Healthy Start). 
Plus she is able to have WIC services the same day. This is accomplished thru coordination 
of services and sharing of records. 



6b. Has this initiative been formally evaluated? Yes 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? This initiative would work if implemented in another urban community since it works 
well in four neighboring cities. Careful planning and commitment of all parties can enhance 
various agencies services without duplication of services. 



7b. Has this program been replicated elsewhere? 



93 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Kent County Health Department 
Grand Rapids, Ml 



CityMatCH CONTACT: 
TELEPHONE: 



Wanda Bierman 
616/336-3002 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Immunization Action Plan - Outreach 

lb. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 

Improving Access to Care - 32 Other outreach activities; 25 Reducing transportation 
barriers; 26 Expanding private sector linkages 
Strengthening Urban Public Health Systems - 43 Immunization tracking, recall systems 



Describe the initiative. This action plan is primarily an outreach activity which has two major 

components: 

1. Newborn - All infants born in Kent County are compiled onto a disc at the Michigan Dept. of 
Health from the newborn blood screening tests. When infants reach 5 weeks of age a letter 
and information on immunization schedules and free clinics locations are provided. A 
refrigerator magnet with the immunization is also included. When the infants reach 3 months 
and/or 5 months of age our outreach workers call them using the computer software "Contact 
Plus." If the family has no phone, a letter is sent requesting a call back. 

The parent is reminded of the original letter and questioned as to the immunization status of the 

infant. If immunizations have not been obtained, the reason is documented and solutions are 

problem-solved. Additional follow-up is provided as necessary. 

2. Immunization Software (ImmunSafeWare) is being developed by our dept. which will include a 
system for follow-up on persons who fall behind schedule. Initially this system will be used in 
all health dept. clinics in the county. When the system is ready, private providers will be 
offered the opportunity to join the system. The goal is to have a county-wide system in place. 
ImmunSafeWare is ready for implementation this Fall. 

3. An additional component of our outreach effort includes an Advisory Committee of community 
representatives from the private and public sector. These are persons vitally interested in 
promoting immunizations in their own agencies (hospitals, doctor's offices, HMOs, pediatric 
clinics) or on behalf of clients utilizing their agencies (day care, schools. Head Start). This 
advisory committee met monthly for the first year and is now meeting quarterly. 



3a. In planning and implementing this activity, what has been the leadership role of your health 

department? Our health department's role has been that of computer software development and 
outreach to the community. We engaged the state health department in providing the newborn 
data set on disc for our use and engaged community leaders in serving on the advisory committee. 
We also sought and received grant monies to assist in this process. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? I believe the community responded very well to this initiative and it is clear that the health 
department is viewed as having a leadership role in the area of immunizations. There has been 
much interest in the advisory committee and the outreach activity. Members have been patiently 
waiting for the software to become available for their eventual use. 



94 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Programmer expertise to write and test 
the software. 

How overcome? The original developer of the 
software changed employment in the middle of 
development. We were able, however, to 
contract with him on a part-time basis while the 
system was being tested, this slowed down the 
development considerably. 



Barrier 2: Staff time to participate in testing and 
implementing the system. 

How overcome? The Immunization Program 
Supervisor made this initiative a priority and flexed 
her hours so she would be available to work with 
the programmer as needed. Key staff were 
identified who could assist with the testing phase. 
Part-time staff were encouraged to work extra 
hours to test the software at times when they 
were not normally needed to deliver direct clinical 
services to clients. 



5. How is it funded? Other: State grant which includes CDC funding. 
What is the approximate annual budget for this initiative? $200,000 

6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Yes, we have 
measurable objectives. The outreach activity to newborns is recorded in a computer software 
program. Reports are generated each month which include number of persons contacted and a 
breakout of reasons for not receiving immunizations. We are monitoring the immunization 
compliance rate of children utilizing the health department's clinics as a measure of outreach 
success. The major accomplishments include implementation of the Newborn Outreach utilizing 
Contact Plus software and compilation of data on reasons given for non-compliance; Development 
of immunization tracking software which is ready for implementation and will eventually be 
available county wide; Formation of an active Immunization Advisory Committee in the community. 

6b. Has this initiative been formally evaluated? No 

7a. Do you think that this initiative would work if implemented in another urban community? Yes 

Why? We are monitored by the state health department. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



95 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's rDost successful recent initiative in the area of nnaternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Kent County Health Department 
Grand Rapids, Ml 

Wanda Bierman 
616/336-3002 



CONTACT FOR MORE INFORMATION: 



1a. Initiative Name: Lead Screening and Tracking Program 

1b. Category(les) that best applies to your initiative: 
Child Health - 1 5 Lead poisoning 

Improving Access to Care - 34 Case management/care coordination 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. Our health department is screening all children 9 months through 
5 years of age who utilize our clinics for EPSDT, WCC or WIC. This amounts to over 
12,000 children during the first year of the project. All children screened are entered into a 
"Tracker" computer system. Referrals are made for secondary screening and once 
confirmed, the environmental health and nursing home visit divisions are activated. All 
three divisions in the health department utilize the "Tracker" system to update current 
status of the child. This computer system is linked to area hospitals as well. The program 
supervisor attends monthly clinics held at an area hospital which case manages lead 
burdened children. 

In addition to the screening and tracking portions of this project we are also involved in 
providing community education and medical CME credits. The program supervisor 
participates on local and state committees aimed at reducing lead poisoning among 
Michigan children. 



3a. 



3b. 



In planning and implementing this activity, what has been the leadership role of your health 
department? Our health department, in collaboration with an area hospital, jointly 
developed the "Tracker" software system. This system allows multiple providers access to 
case management information. Our health department has been aggressive in screening 
children who may be at risk of lead poisoning. The media look to us as experts on lead 
poisoning in our community. 



Has the leadership of the health department been enhanced as a result of this activity? 
so, why? I believe it has been enhanced as viewed by the state with whom we have a 
contract and with the two area hospitals with whom we collaborate. This project has 
helped to strengthen the coordination within the various divisions of our county health 
department and improved case management. 



If 



96 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Motivation of parents/guardians to 
get a confirmatory test performed if the 
capillary screen was high. 

How overcome? Several contacts are made 
and if no response, then a referral is made to 
our community nursing division to make a 
home visit. We have considered the 
possibility of obtaining venous samples for 
screening, however, the pros and cons are 
still being considered. 



Barrier 2: Training our clinic technicians to 
avoid contamination of the capillary specimen 
through proper technique. 

How overcome? The main method is to train 
our clinic technicians in proper technique. We 
have obtained a better capillary collection 
device which has improved this problem. The 
original collection device provided by the state 
was difficult for our staff who see a large 
number of children in a very busy clinic. 



5. 


How is it funded? 


City/County/Local government funds; 


State grant ■ 


part of federal 




initiative. 












What is the approximate annual budget for this initiative? 


$100,000 





6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Yes, we have specific objectives which are monitored quarterly. Major accomplishments 
include implementation of new computer software, TRACKER; screening over 12,000 
children during the first year; improved community collaboration and case management. 

6b. Has this initiative been formally evaluated? Yes 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? If a tracking system could be developed. Screening children on the WIC program 
gives access to an at-risk population. This does increase the time needed to complete 
blood testing and has an impact on staffing clinics. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



97 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Guilford County Health Department 
Greensboro, NC 



CityMatCH CONTACT: 
TELEPHONE: 



Earle H. Yeamans 
910/373-3273 



CONTACT FOR MORE INFORMATION: Mary M. Sappenfield 



1a. Initiative Name: Healthy Years Ahead 

lb. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 

Improving Access to Care - 26 Expanding private sector linkages; 32 Other outreach activities 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. The initiative consisted of immunization outreach activities designed to: a) 
improve community awareness, b) improve access, and c) mobilize the health, business, and civic 
community around immunizations. A series of 5 consecutive Saturday clinics were held for 3 
hours each in non-traditional locations throughout the county to provide immunizations. 
Advertising (not PSAs) was via radio, television, newspaper, and flyers. Primary sponsors were 
solicited and included a local radio station, TV station, and local business franchise. Live radio 
spots were held on site at 4 of the locations. Prizes and incentives were awarded to participants. 

Clinics were held at an Urban Ministry Health Center, a Health Department location that previously 
had not been available on weekends, at local business locations (JiffyLube - automobile lubrication 
franchise), and at a University-sponsored family awareness activity that drew several thousand 
people. Children were registered by volunteers from civic groups; Health Department staff 
reviewed immunization records to determine needs; cellular phones (loaned) were used to call back 
to the Health Department to check computers or call private MDs as needed; Health Department 
staff administered vaccines; local pediatricians were on site to provide consultation as needed; 
volunteers conducted client surveys; prizes were distributed by company reps or volunteers. 
Success - future community activities are being planned with the same volunteers; this initiative 
has strengthened the Health Department's role as a community coalition builder. 



3a. In planning and implementing this activity, what has been the leadership role of your health 

department? Health Department acted as a catalyst to bring together local pediatricians, civic and 
religious groups, and businesses. It provided top level administrative and professional program 
support through active participation at each monthly meeting and on location during clinics (Child 
Health Director, Nursing Director, Immunization Nursing Supervisor, Immunization Health Eduator). 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Yes. Through the partnership effort, local businesses, civic, religious, and medical groups 
were able to experience first-hand the professional expertise of Health Department staff. These 
groups have started planning future activities with the Health Department. 



98 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Advertising: Needed to create 
community awareness of immunization issues 
and announce the clinics. 

How overcome? A marketing plan was 
developed by the radio station and business 
members of the group. PSAs were ruled out as 
being a reliable source of advertising during 
convenient times and with the extent of coverage 
needed. 



Barrier 2: Funding for a marketing campaign. 

How overcome? The local radio station sponsor 
solicited local business to donate funds or other 
tangibles to the immunization initiative in 
exchange for radio advertising time. Newspapers 
provided intense coverage several times each 
week. TV stations covered the events and aired 
promotional announcements through the 
month-long initiative. 



5. How is it funded? All donated by local business. 

What is the approximate annual budget for this initiative? $40,000 for marketing. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Specific, 
measurable objectives were not established. The primary goals were to increase public awareness 
of immunization issues and to directly involve many different community groups in a public health 
issue. Announcements were made on the radio every 15 minutes during prime time each day 
during the month of the project; newspaper articles appeared in 15 issues; TV spots aired at 
frequent prime time intervals during the 5 week period. 23 different agencies, groups, or 
businesses were represented in the planning and implementation. 

335 children registered for the clinics; 291 children received a total of 855 doses of vaccine. 71 
of the 291 were delinquent by an average of 14 months. Surveys indicated a) Saturdays more 
convenient for families, b) easier access when located throughout the community, and c) publicity 
was a key factor in awareness and use of services. 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? With a corporate sponsor and if business leaders are involved in all phases of planning and 
implementation. They have unique experience in marketing and soliciting to reach vast numbers of 
people and raise sufficient sums of money and donated/loaned products to impelement the project. 



7b. Has this program been replicated elsewhere? No. 
If yes, where? 



99 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Marion County Health Department 
Indianapolis, IN 



CityMatCH CONTACT: 
TELEPHONE: 



Elvin Plank 
317/541-2347 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Maternal and Child Health Outreach Program 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 06 Home visiting 
Improving Access to Care - 32 Other outreach activities 



Describe the initiative. Indianapolis has provided multidisciplinary care coordination team 
service in high risk neighborhoods of the City for almost five years. These teams are 
composed of nurses, social workers, nutritionists, and community health workers. So 
much energy and time is required to meet the needs of those clients that are referred that 
almost no time is left to do door-to-door outreach. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Marion County Health Department has provided the entire leadership for 
this project. We did work closely with the Indianapolis Division of Housing and the Welfare 
Department in the implementation phases. The Housing Division actually agreed not to 
raise the rents of the persons we employed for a period of 18 months. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The success of this program in identifying women and children in need has thrust 
the Health Department into a more visible leadership role with the Welfare Department, the 
Housing Division as well as City government leaders. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Making it financially feasible for 
women to work without loosing more benefits 
than the wages they gained. 

How overcome? Negotiated an agreement 
with the Division of Housing so they would 
not raise rents for 18 months. 



Barrier 2: Many of the women in the public 
housing communities don't want others to 
know their "business" so they would not let 
the workers in. 

How overcome? This was one of the big 
reasons for having the outreach workers work 
in apartment complexes outside of their own. 



100 



5. How is it funded? City/County/Local government funds. 

What is the approximate annual budget for this initiative? $100,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? All 
contacts with persons who are referred for services are documented. The objectives are to 
have fewer women deliver a baby without prenatal visits per patient. The major 
accomplishment of this program to date is simply the number of women and children who 
have been reached and referred. 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? I 
think this approach would work in any urban community. 

Why? The success of the program is dependent on employing staff who feel comfortable 
with making "cold calls" to people they do not know and then being very non-judgmental 
with the people they come into contact with. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



101 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Hinds County Health Department 
Jackson, MS 



CityMatCH CONTACT: 
TELEPHONE: 



Don Grille, MD 
601/987-3977 



CONTACT FOR MORE INFORMATION: Minta Uzodinma (601/960-7951) 



1a. Initiative Name: Nurse Sonographer 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 05 Expanding maternity services 



Describe the initiative. In 1983 select nurses and nurse practitioners were recruited and taught 
sonography procedures. These candidates were recomnnended by the supervising nurse for the 
course and had maternity experience. They had demonstrated the ability to assume increased 
responsibility and were willing to learn the procedure and perform the activity on a regular basis as 
assigned. 

The formal training program that was developed in cooperation and consultation with the 
Mississippi Board of Nursing includes reading assignments, a lecture by a knowledgeable 
physician, hands-on demonstration and practice with a patient, and a written test prior to 
completing 20-30 hours of clinical instruction and supervised practice. After successful, seifpaced 
completion of the course objectives, the nurse is awarded an agency certificate of recognition as a 
nurse sonographer. Nurses are taught to perform a basic screening sonogram which meets ACOG 
standards and includes. 1) number of fetuses, 2) position of fetus, 3) location of placenta, 4) 
cardiac activity, 5) fetal movement, 6) general body scan of gross malformations of fetal anatomy, 
7) amniotic fluid volume, and 8) biometry. 

The procedure is often done with portable equipment which the nurse may transport from clinic to 
clinic. The calculations of specific measurements are done with programmed hand-held 
computers, if not already part of the particular equipment's menu. The data is recorded on the 
agency sonogram referral report form. Polaroid pictures or thermal print of the fetal head, fetal 
femur, presenting part and placenta location are attached to the report and sent to the obstetrical 
consultant for interpretation and management recommendations. 

The nurse sonographer is not asked to identify fetal abnormalities or sex, but a scan for 
abnormalities is mandatory. Gynecological ultrasounds and targeted ultrasounds must be referred 
to other sources. In selected cases, the nurse sonographer may do an ultrasound for detection of 
the gestational sac. Under no circumstances does the nurse sonographer interpret the results. If 
an urgent or emergency interpretation is required, a consult must be sought from a local qualified 
radiologist or obstetrician gynecologist. 

Nurses who are certified to perform sonograms are required to attend an agency sponsored annual 
update and continue to perform at least 18 sonograms each year in order to maintain certification 
to practice in the health department. The obstetrical consultant evaluates the quality of the 
nurse's work as he receives the referral report and pictures. If the content of data is 
unsatisfactory, he will counsel the nurse and provide additional clinical teaching as indicated. 



102 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Hinds County Health Department has 3 nurse sonographers. Hinds County is the 
training site and yearly recertification site for nurse sonographers. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Hinds County was one of two county health departments to pilot the implementation of 
Universal AFP screening. With implementation of Universal AFP, the need for sonograms have 
increased. Because Hinds County provides 55% of the prenatal care to residents of the county. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Purchasing equipment. 

How overcome? Central Office helped purchase 
equipment and paid for equipment maintenance 
for the first year. 



Barrier 2: Staff turnover. 

How overcome? Because of the many job 
opportunities for nurses in the Jackson 
metropolitan area turnover is a problem. The way 
to help rectify the problem was to have more than 
one nurse sonographer trained at any given period. 



5. How is it funded? Third party reimbursement (Medicaid, insurance) 
What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? The three nurse 
sonographers performed 3,540 sonograms in FY 1994. Data is collected via the Patient 
Information Management System (PIMS) and the Third Party Billing office. Nurse sonographers are 
required to be recertified yearly and this information is kept in the nurse's personnel file. 

6b. Has this initiative been formally evaluated? Not applicable. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? It is very cost effective and helps to assure early access for a needed service. It does not 
require hiring additional staff. It is another source of income for the health department. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? Statewide - almost every Public Health District has at least one nurse sonographer. 



103 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Duval County Public Health Department 
Jacksonville, PL 



CityMatCH CONTACT: 
TELEPHONE: 



Donald Hagel, MD 
904/354-3907 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Improving EP Services by Networking 

lb. Category (ies) that best applies to your initiative: 
Women's HeaJth - 02 Family Planning 
Perinatal Health - 09 Breastfeeding/nutrition/WIC 
Improving Access to Care - 26 Expanding private sector linkages 
Strengthening Urban Public Health Services - 41 Building coalitions and partnerships 



2. Describe the initiative. In response to the need of comprehensive care coordination and case 

management of post partum patients, the Duval County Public Health Unit initiated an intensive effort 
to visit, counsel and start every new mother on a birth control method prior to leaving the hospital. 
The plan was first implemented in November 1993 at the University Medical Center where the 
majority of public health patients were delivered. Two public health nurses were placed at the 
hospital and now see approximately 250 patients per month. Each mother is counseled, started on an 
appropriate form of birth control and is further assisted in receiving referral services for newborn care 
and other family health needs. A magnetic wipe-off memo board listing telephone numbers for WIC, 
Healthy Start, Parenting Classes and Clinic Information and allowing a space to write in appointments 
and other numbers is also given to the patient as they are counseled on referral sources. 

As patients usually seen in the public health maternity clinics moved into the private sector due to 
new Medicaid managed care programs, the MCH staff realized the need to initiate a family planning 
outreach program at other city hospitals. Review of records indicated the patients eventually did 
come to public health clinics for family planning, or in many cases for pregnancy tests, and were in 
need of public health services. Therefore, the public health unit expanded the visitation program to 
the hospital with the highest number of Medicaid deliveries. An ARNP is stationed at the hospital and 
provides the counseling, a start-up birth control method and provides linkage with other sources of 
assistance for the newborn and family members. 



3a. In planning and implementing this activity, what has been the leadership role of your health 

department? The Duval County Public Health Unit assumed the leadership role in this initiative. In 
the planning phase, the Director of Women's Health Services obtained administrative approval and 
then contacted all providers and agencies involved to design a plan. The effort was implemented, 
after review by all parties by the public health unit in cooperation with the two hospitals involved. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, why? 

Yes. As the health care systems were changing rapidly, private providers and other public providers 
became acutely aware of the need for expanded care for the new mother, especially those on 
Medicaid or with limited socio-economic resources. It became evident that a public health approach 
to care would be an assistance to both the family and the medical provider. 



104 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Funding source for salaries, office space 
and supplies. 

How overcome? Lengthy negotiations with fiscal, 
legal, and medical providers resulted in cooperative 
agreements for payment for salaries and supporting 
resources. All involved realized the social and 
economic benefits of the program. 



Barrier 2: Short length of hospital stay for 
maternity patients and weekend and holiday 
coverage. 



How overcome? A specific process for receiving 
the patient names from the delivery room staff was 
developed by the family planning staff at each site. 
Family planning staff then makes four rounds per 
day to contact the patients. At this time, weekend 
coverage is not available, however, with four 
rounds per day, few patients are missed if deliveries 
occur on Sundays. 



How is it funded? City/County/Local government funds. 

What is the approximate annual budget for this initiative? Annual budget under development with 
new initiative. Salaries account for the majority of the costs. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Measurable 
objectives : The first process objective was to develop and implement the plan and measure the 
number of post partum patients placed on birth control. As the program develops, the long term 
measurement will affect the indicators set for teenage pregnancy and numbers of unplanned 
pregnancies. Major accomplishments to date include : Expansion to second site, increased 
compliance rates for post partum visits, increased compliance with birth control method, and a gross 
decrease in pregnancy rate for public health assigned patients. 

6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? Yes, if 
careful planning precedes implementation. 

Why? As health care reform continues to evolve the comprehensive needs of the maternity/post 
partum patient will need to be shared by the private sector and the public health community. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



105 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Wyandotte County Health Department 
Kansas City, KS 

Margaret Daly, ARNP 
913/573-6714 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: High Risk Prenatal and Preterm Labor Prevention Program 

lb. Category(ies) that best applies to your initiative: 

Prenatal Health - 04 Prenatal care; 07 Low birthweight/infant mortality 



Describe the initiative. Residents of Wyandotte County are at high risk for delivering 
infants prematurely and/or low birth weight due to the prevalence of many risk factors. 
The goals of the Maternal and Infant Program (M&l) are to: improve pregnancy outcomes; 
and, reduce the risk and incidence of low birthweight infants, maternal and infant morbidity 
and mortality, and child abuse. Local projects facilitate access to prenatal care, promote 
early entry into care, and compliance with prenatal care for adolescents and other high risk 
mothers and health care for their infants. 

The program features risk identification of all prenatal patients using a multi-disciplinary 
approach and providing unique services as well as traditional medical services. Three 
unique features of the high risk prenatal program initiative: 1) identifying women at risk for 
preterm labor and delivery and working in a concentrated way with these women; 2) 
providing ancillary support services, such as transportation, social work and nutrition 
counseling, and home visiting to high risk prenatal patients of PRIVATE obstetricians in the 
community; and 3) staff includes a substance abuse counselor on site to work specifically 
with pregnant women and their families. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The program was initiated because of the concern of continuous poor 
outcomes in Wyandotte County despite a comprehensive prenatal program at the health 
department available to all residents. The OB consultant who started the program in 1968 
and the prenatal coordinator sought out reasons and ways to improve birth outcomes in the 
community. The program was requested and presented over the Metropolitan area and 
throughout the State of Kansas. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The leadership has been enhanced by better collaboration within the community 
and by the awards and recognition received. 



106 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : The need to maintain commitment 
and cooperation of multiple staff that need to 
be involved, i.e: hospital nurses, ER staff, 
clinical staff. 



How overcome? 1 ) Continuous staff 
education needs to be done. 2) Frequent 
feedback of the outcome - good and poor. 3) 
Administrative support from each institution 
involved. 4) Staff turnover. 



Barrier 2: Perinatal drug abuse. 

How overcome? We have not found a 
solution to such an enormous problem. 
Outreach to welcome women in for care; 
non-judgmental attitudes; lack of threat of 
penalty; risk assessment; education; 
counseling; referral for follow-up; supportive 
services. 



5. How Is it funded? City/County/Local government funds; MCH block grant funds; Private 
sources: March of Dimes; Third Party Reimbursement; Other: patient fees. 

What is the approximate annual budget for this initiative? $500,000 plus. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? The 
specific measurable objectives have been the preterm delivery rate. The data is collected 
by monitoring weeks of gestation at delivery. Review of all questionable PTD and all LBW 
records. The accomplishments have been that when the program is in full support, the PTD 
and LBW rates can be decreased. When it is not (ie: 1993) the rates will increase. 

6b. Has this initiative been formally evaluated? Yes. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? It is felt the program can work anywhere when it is supported by the community. 
For the program to work, it takes all prenatal staff, in-patient and out-patient nurses, 
physicians, administration, support staff, and especially the patient and her family. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



107 



1994 Urban MCH Leadership Conference Profile 



Describe your health departnrient's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Kansas City Health Department 
Kansas City, MO 

Sid Bates 
816/474-8140 



CONTACT FOR MORE INFORMATION: Cynthia Davis (816/474-8140) 



la. Initiative Name: Employee Development Seminars, WIC Services 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 09 Breastfeeding/nutrition/WIC 



Describe the initiative. The Kansas City Health Department's WIC Program experienced a 
40% increase in participant caseload in the last five years, with corresponding staff 
expansion. At the same time the program transitioned from a manual service system to an 
electronic mainframe base, creating increased knowledge requirements. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Realizing the need for a comprehensive training effort, the WIC program 
requested funding from the State Health Department for consultant work relating to actual 
seminar development. Funding was provided with the stipulation that selected State staff 
also receive that training and the development modules be made available to other WIC 
programs state-wide. Pilot seminars were conducted at the health department with WIC 
program then expanded to agency sub-contractors, and finally other WIC programs state- 
wide. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? The leadership of the health department WIC program has been enhanced in 
several ways: 

1 ) by developing skills in seminar preparation 

2) by exposure to the contacts of the seminars 

3) by collaboration with the State WIC agency and 

4) by contact with other WIC agencies concerning seminar development and presentation 



4. What have been the greatest barriers faced in implementing this Initiative? 



Barrier 1 : Employee turnover reducing 
training effectiveness. 

How overcome? Conduct the seminars 
annually, utilize the buddy system for new 
employees. 



Barrier 2: Scheduling five seminars within one 
year for three subcontract agencies. 

How overcome? Use of E-mail to coordinate 
available presentation dates for all agencies 
simultaneously and to provide adequate 
advance scheduling. 



108 



5. How is it funded? Other Federal funds. 

What is the approximate annual budget for this initiative? $16,230.00 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Measurable objectives were involved in actual seminar development and pilot presentations. 
Seminar effectiveness was measured by staff termination rates, employee grievances, 
observed employee/customer relationships, and results of annual client satisfaction surveys. 



6b. Has this initiative been formally evaluated? 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? It should prove particularly beneficial in a service setting where there is high volume 
and high demand for the services provided. Employee burn-out and frustration are always a 
possibility with attendant carry-over to the client. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



109 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Knox County Health Department 

CITY/STATE: Knoxville, TN 

CityMatCH CONTACT: Bea Emory 

TELEPHONE: 615/544-4214 

CONTACT FOR MORE INFORMATION: Karen Bateman, Elaine Wallace 



la. Initiative Name: Enhanced Immunization Tracking/Recall System 

1b. Category(les) that best applies to your initiative: 

Strengthening Urban Public Health Systems - 43 Immunization tracking, recall systems 



Describe the initiative. Due to the decrease in the immunization rate of children less than 
24 months of age, changes needed to be made in the tracking system previously used to 
include patients of both public and private sources. Newborn mailers, periodic (4,8,19 
month) mailers requesting shot information, MMR reminder postcards and overdue cards for 
public patients were all produced as well as the necessary computer changes to generate 
the needed information. 

In addition to the mailing, the computer periodically prints a list of vaccine delinquent 
children. With the use of an auto-dialer, parents are contacted to remind them of needed 
immunizations. If the child remains unimmunized, then an outreach worker will make a 
phone call and/or a home visit if needed. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The health department already having an established link through birth 
certificate registry allowed for implementation of such a tracking system. The initiative 
was taken following a survey of local private practitioners, most of who provided no recall 
system and expressed a desire and need for such a system. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The parents of children both public and private have responded positively to our 
new system and have been very willing to provide immunization information to us. An 
explanation of the department's role and purpose is explained to parents through the 
mailers and personal phone calls. Private physicians offices are also cooperating with the 
additional shot information requests via fax. The perception is that we are providing a 
needed service to both parents and practitioners. 



110 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Computer system changes needed 
to be revised to accommodate the new 
registry while not affecting other health 
department services. 

How overcome? A contracted computer 
programmer was brought in to work with the 
system and make the necessary changes 
which involved numerous hours of technical 
support. 



Barrier 2: Creating and producing the new 
mailers and reminder cards. 

How overcome? Through numerous meetings 
with health department staff and an outside 
vendor, the mailers were created. Many 
changes and updates had to be made along 
the way prior to the actual printing. Once a 
consensus was reached the printing was 
completed and the system was activated. 



5. How is it funded? City/County/Local government funds. 

What is the approximate annual budget for this initiative? $20,000 (mailers & postage) 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? The 
computer system generates a list of children who were sent mailers. On this list records 
are kept when a response is received. One to two weeks following the mailers an 
automated phone message reminding parents to respond is sent. After this personal phone 
call/home visits are made. 

In 1993 our 24 month old survey indicated a completion rate (4:3:1) of 72.9% of children. 
Our 1994 survey indicates an increase of almost 10% to 82.3%. 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? 
This initiative could be implemented anywhere a local birth registry is established. 

Why? Once this information is available an immunization follow-system can be generated. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



Ill 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Jefferson County 
Lakewood, CO 



CityMatCH CONTACT: 
TELEPHONE: 



Mary Lou Newman 
303/239-7001 



CONTACT FOR MORE INFORMATION: Irene Bindrich 



a. Initiative Name: Assurance of Program Outcomes Through the Use of Total Qquality 
Management (TOM) 

1b. Category(ies) that best apply to your initiative: 

Other - Not Elsewhere Listed - 45 Total Quality Management (TQM) 



Describe the initiative. This project demonstrates that Total Quality Management (TQM) 
can be utilized as a successful model to assure that consumers are satisfied with program 
services and outcomes. TOM is a process that is consumer focused, and involves 
managers and staff is using a systematic approach to measure and evaluate program 
process and outcomes. 

TQM was implemented to evaluate the Health Care Program for children with special needs 
(HCP) in our county. Our purpose was to improve consumers' satisfaction with HCP 
services, and improve coordination of HCP administrative duties by state and county health 
departments. A diagram of each major step in the HCP program was created to ensure 
consistency in the delivery and outcomes of the HCP program. Problem areas and 
duplication of services were identified and theories about the causes and efforts of these 
areas were generated. Data collection was obtained by surveying the HCP staff and 
families to gather their perceptions and expectations of the quality of the HCP Program. 

The survey results revealed that the HCP Program did not meet the expectations of the 
nursing staff and families. These findings were presented to state and local HCP 
administrative staff and resulted in the state funding the administrative functions of HCP at 
our county health department. The decentralization of the HCP will improve access, 
linkages and utilization of community resources. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? TOM shifts traditional management in measuring programs by consumer 
standards, implementing methods to obtain consumers' feedback and expectations and 
involving managers and staff in a proactive approach to evaluate program services and 
outcomes. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? TQM has provided a model which empowers staff to identify processes that are 
inefficient, development of strategies to measure the cause and effect of these inefficient 
areas and implement changes that improve quality of care. 



112 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Resistance to new method in 
program evaluation. 

How overcome? Training staff in TQM and 
assisting them in the implementation. 
Achieving successful results and increasing 
their satisfaction in delivering HCP services. 



Barrier 2: Resistance of State HCP staff 
utilizing consumers' standards in evaluating 
services. 

How overcome? Presenting survey findings as 
objective data. 



5. How is It funded? City/County/Local government funds 

What Is the approximate annual budget for this initiative? $3,500 (meeting time). 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What are the major accomplishments to date? D 
Responsiveness - the willingness of the family to utilize CHN assistance and community 
services. 

14% of the families contacted by the CHN had moved. 
38% of the families did not respond to the CHN contact. 

Distribution of HCP referrals sent by state: 
August - 1 39 referrals 
Sept - 22 
Oct - 5 

Solution: initiate CHN referrals at the time of the HCP application to improve the timeliness 
of family contacts. 

6b. Has this initiative been formally evaluated? Yes 

7a. Do you think that this initiative would work if implemented in another urban community? 
Absolutely. 

Why? TQM has been initiated and in the business community for years and is a national 
trend in improving quality of services and products. 

7b. Has this program been replicated elsewhere? Yes, Denver hospitals. 



113 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Ingham County 
Lansing, Ml 



CityMatCH CONTACT: 
TELEPHONE: 



Bruce Miller 
517/887-4311 



CONTACT FOR MORE INFORMATION: 



1a. Initiative Name: Clinic Specific Infant Mortality Study 

lb. Category(ies) that best apply to your initiative: 

Prenatal Health - 07 Low birthweight/infant mortality 



Describe the initiative. "Clinic Specific" infant mortality rate was determined by obtaining 
copies of the birth and death certificates of all Ingham County infants who died during the 
1986-1990 period and using identifying information from certificates to determine if the 
infants who died were born to women who received part or all of their prenatal care at the 
Health Department's prenatal clinic. 

The criteria for including an infant death in the calculation of the clinic specific mortality 
rate was a minimum of one prenatal visit at the Health Department. Women who were lost 
to follow-up and women who transferred to providers other than the Sparrow OB/GYN 
Clinic prior to delivery were not included in the numbers used to calculate the clinic specific 
infant mortality rate. However, no effort was made to exclude the infant deaths in this 
group. If women lost to follow-up and women who transferred to other providers had been 
included, the clinic specific infant mortality rate would have been lower. 

The study showed that the rate for infants born to women who used the Ingham County 
Health Department prenatal clinic was 6.8 per 1000 live births. The infant mortality rate in 
Ingham county as a whole during the five year period was 9.7 infant deaths per 1,000 live 
births. 

Given the racial mix in the clinic population and the relative risk for infant mortality in 
different racial groups, the expected infant mortality rate for the clinic population during the 
time period was 1 1 .2 per 1,000 live births. The actual rate of 6.8 was nearly half of what 
would be expected given the racial and ethnic mix of clinic patients. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The department designed and conducted the study. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The department has received considerable publicity as a result of the study. 



114 



4. What have been the greatest barriers faced in implementing this initiative? 


Barrier 1 : Not aDDlicable 
How overcome? 


Barrier 2: Not aoDlicable 
How overcome? 





5. How is it funded? City/County/Local government funds; General state funds; MCH block 
grant funds. 

What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? D 
Documenting infant mortality in a MCH clinic. 

6b. Has this initiative been formally evaluated? 



7a. Do you think that this initiative would work if implemented in another urban community? 
This Initiative might work in other communities that surround pregnant women with a 
comprehensive array of services. 

Why? 
7b. Has this program been replicated elsewhere? 



115 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



City of Laredo Health Department 
Laredo, TX 

Lisa Sanford 
210/723-2051 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Laredo Immunization Coalition 

1b. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 

Improving Access to Care - 26 Expanding private sector linkages; 25 Reducing 
transportation Barriers; 32 Other outreach activities 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



2. Describe the initiative. The Laredo Immunization Coalition is composed of the City of 

Laredo Health Department, Mercy Regional Medical Center (Public, NonProfit), Texas Border 
Immunization Initiative (Public), Laredo Catch (Community Access to Child Health Care) 
(Private, Non-Profit), Laredo Independent School District and the United Independent School 
District. The mission of the coalition is to increase the availability of immunizations to the 
Webb County Community by pooling resources. The coalition is also committed to the 
provision of adult health Screening and educational activities. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The City of Laredo Health Department has spear-headed the development of 
this coalition, chairing the committee and coordinating activities between agencies. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Leadership has been enhanced by strengthening ties with local agencies and 
increasing the visibility of the health department. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Philosophical difference in the 
provision of health care. 

How overcome? Through regularly 
scheduled meetings held in a central location 
(breakfast meeting at a favorite restaurant), 
dialogue has opened up in a relaxed 
atmosphere which permits and even 
encourages discussion of philosophies. 



Barrier 2: 

How overcome? 



116 



5. How is it funded? City/County/Local government funds; General state funds; 330 funds; 
Private sources - Sisters of Mercy Texas Pediatric Associations; and Other - Donations from 
local Merchants. 

Each coalition member is self-supporting; activities are provided as in-kind. 

What is the approximate annual budget for this initiative? N/A 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? The 
Laredo Immunization Coalition it self does not currently have goals/objectives. These are 
under discussion at the present time. Here to fore, each agency has completed their 
required reports, with immunization records being filed centrally at the health department. 

6b. Has this initiative been formally evaluated? No 

7a. Do you think that this initiative would work if implemented in another urban community? 

Why? The coalition is still very young and remains "informal" yet has been effective here. 
If a close-knit group is formed, I believe it can be replicated. 

7b. Has this program been replicated elsewhere? Don't know. 

If yes, where? 



117 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Lexington-Fayette County Health Department 

CITY/STATE: Lexington, KY 

CityMatCH CONTACT: Regina Moore 

TELEPHONE: 606/252-2371 Ext. 431 

CONTACT FOR MORE INFORMATION: Caria Cordier 



1a. Initiative Name: Maternity Program 

1b. Category(ies) that best applies to your initiative: 

Women's Health - 01 Preconception health promotion 
Prenatal Health - 05 Expanding maternity services 



2. Describe the initiative. The Maternity Program currently provides Comprehensive Maternity Care 
beginning with an intake visit with the Clinical Assistant, Nurse, and Nutritionist. The visit takes 
place usually within the same week that the patient requests services. The patient is referred to an 
OB provider, with whom the agency contracts to provide prenatal care, including various tests and 
procedures, as indicated throughout labor and delivery, including hospitalization for the mother and 
newborn, and throughout eight weeks post partum. The program offers preterm labor management. 
The patient receives nursing/nutrition counseling, off site at the University of Kentucky OB/GYN clinic 
during the doctor visit, as well as onsite. These services are coordinated with WIC visits as much as 
possible. The patient also receives home visits prenatally and post partum. The program offers 
childbirth, prenatal, breastfeeding, and smoking awareness classes. 

An expansion of the Post Partum/WIC clinic includes preventive health care, age appropriate risk 
assessment, pregnant, post partum, breastfeeding risk assessment, and counseling which includes 
family planning, well child, post partum exam visits, self breast exam, and preconceptional health risk 
assessment and counseling. Patients are provided these services through eight weeks post partum. 

Preconceptional Health services continue as indicated for family planning, pregnancy test visits. 
Folic Acid supplementation and counseling regarding the relationship to the decrease in the incidence 
of neural tube defects is included in the preconceptional health counseling as well as during early 
pregnancy counseling. 

Enhanced maternity care which includes providing monthly counseling visit, maternity classes and 
home visits is offered/provided for those patients who have a provider for medical care but can 
benefit from these support services. 

In February 1994, some of the Maternity Program Clinic and Field Service staff met with the 
Coordinator of the Mother Baby Unit at the University of Kentucky Medical Center, and coordinated a 
system which improves the continuity of care for patients seen by both the Lexington-Fayette County 
Health Department Maternity Program and the University of Kentucky Medical Center OB/GYN staff. 
This system allows the nurse to obtain needed perinatal information, provide education, answer 
patient questions, encourage and assist with linking the mothers and their infants to WIC, family 
planning, post partum, well baby services, and any other appropriate services. 

This system was implemented February 16, 1994 and has been successful. Patients have stated 
that they are appreciative of the visit, especially by someone who they have seen during their prenatal 
care. Obtaining needed perinatal information is more successful. It is anticipated that more patients 
will present for services as listed above. 

In February 1994 the state Prenatal Program allocated $32,000 to hire a Social Worker in the 
Maternity Program. The basic objective of this position is to provide social services for Maternity 
Program clients both on site and at the University of Kentucky OB/GYN clinics. The development of 
the job description and the recruitment process was a joint effort between the staff from the 
University of Kentucky OB/GYN Department and the Lexington-Fayette Health Department. 



118 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The planning and implementation activities were cooperative efforts between the 
University of Kentucky OB/GYN Clinic, Private Obstetrician, and the Lexington-Fayette County Health 
Department staff. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, why? 

Communication among staff of all agencies and the coordination of patient care of patients seen 
jointly by these agencies has been enhanced. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Space for staff to provide services is a 
problem. 

How overcome? The University of Kentucky 
OB/GYN clinic staff had renovated their clinic. 
Space was assigned for our staff to use. 
Counseling rooms were available at the Health 
Department on the first and second floors, and the 
annex. Space continues to be a problem at the 
Health Department since clients must move to 
several different areas for a complete visit. 



Barrier 2: 

How overcome? 



5. How is it funded? City/County/Local government funds; MCH block grant funds; 330 funds; Third 
party reimbursement: Medicaid. 



What is the approximate annual budget for this initiative? $530,31 3 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Yes, a program plan 
and grant detailing objectives and goals is submitted to request state and federal funding. Monthly 
computerized and manual reports are generated and analyzed. July 1, 1993 through March 31, 
1994, 673 Medicaid and non-Medicaid women have been admitted in the program. There have been 
2,989 nurse visits provided. There have been 613 participants who have attended classes. It has 
been projected that 840 women will be enrolled, 3,685 nurse visits provided, and 883 class 
participants 7/1/93 through 6/30/94. 



6b. Has this initiative been formally evaluated? Yes. 



7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? This initiative could be successful in any area if there is communication and collaboration 
between those agencies and providers who provide this service. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



119 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Lincoln-Lancaster County 
Lincoln, NE 



CityMatCH CONTACT: 
TELEPHONE: 



Carole Douglas 
402/441-8051 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Teddy Bear Cottage 

lb. Categorylies) that best apply to your initiative: 

Prenatal Health - 04 Prenatal care; 07 Low birthweight/infant mortality 
Adolescent Health - 20 Teen pregnancy 

Improving Access to Care - 24 Overcoming racial/ethnic/language/cultural barriers; 32 
Increasing social support systems 



Describe the initiative. The City of Lincoln, Nebraska has small but growing minority 
populations. Except for the Southeast Asian community which has primarily settled in one 
neighborhood, families of minority ethnic cultures are widely disbursed. Health indices 
reveal that there are still wide gaps between people of color and people of the dominant 
culture. Infant mortality, late entry into prenatal care and teen pregnancy continue to 
contribute to high rates of morbidity and mortality among racial ethnic minorities. 

The Teddy Bear Cottage was stimulated by the Healthy Homes Project, a CISS-funded 
minority maternal and child health outreach program in a collaborative effort with the March 
of Dimes, YWCA, University of Nebraska, Lancaster County Cooperative Extension, and 
Kiwanis Clubs of Lincoln. The Cottage provides incentives for pregnant women on limited 
incomes to earn "Teddy Bear Credits" to use in securing clothing and nursery items. 
Credits are earned by seeking first trimester prenatal care, by keeping prenatal and well 
child appointments and by making informed decisions related to pregnancy, parenting, 
nutrition and health. In its first year, the Teddy Bear Cottage expects to serve at least 50 
expectant mothers and their children. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? This project was conceived by the staff of the Healthy Homes Outreach 
program who observed that there were service organizations interested in assisting low 
income pregnant women. Staff felt that an earned incentive program would encourage 
behavior changes as well as get participants needed clothing and infant care items. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. This group of organizations had not worked together on a maternal health 
project before. Also, the project has lead to greater visibility especially in the community 
using the Hispanic Community Center. 



120 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Locating a space in a facility that 
serves people of all cultures. 

How overcome? After several failed 
attempts to find space in a central site 
appealing to all cultures the group decided to 
locate the Cottage at the Hispanic Community 
Center, with space to donate, central to most 
of the population and on the major bus 
routes. 



Barrier 2: 

How overcome? 



5. How Is it funded? 

What is the approximate annual budget for this initiative? $3,875 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? D The 
project has four simple but measurable objectives. Data is collected by the outreach 
workers from Healthy Homes and reported to the cooperating organizations at regular 
meetings. To date, the site has been located and marketing materials developed. 
Merchandise is being inventoried and other service organizations are being approached to 
participate. We hope to be operational by October, 1 994. 



6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? This is a replicable project in any community that has service organizations willing to 
volunteer hours in the Cottage and to raise funds to purchase merchandise. We believe 
that there are health care providers who are also interested in supporting the efforts if it is 
successful in achieving healthier outcomes. 



7b. Has this program been replicated elsewhere? Yes 



121 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Long Beach Department of Health & Human Services 

CITY/STATE: Long Beach, CA 

CityMatCH CONTACT: Mohamed A. Hafez, MD, MPH 

TELEPHONE: 310/570-4042 

CONTACT FOR MORE INFORMATION: 



1a. Initiative Name: Black Infant Health Project 

lb. Category(ies) that best applies to your initiative: 

Prenatal Health - 04 Prenatal care, 07 Low birthweight/infant mortality 

Improving Access to Care - 30 One-stop shopping, co-location of services; 32 Other outreach 

activities; 35 Increasing access to Medicaid 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. In response to an African American Infant Mortality rate in the City of 
Long Beach which had reached 23.9 deaths per 1000 live births in 1989, the Long Beach 
Department of Health and Human Services actively pursued additional resources to address the 
problem. 

In January 1991, the Department received funding from the Maternal and Child Health 
Branch of the State Department of Health Services for a Black Infant Health Project. The project 
was initially funded for a period of 30 months with a goal of maximizing positive pregnancy 
outcomes to improve survival rates for African American infants. The project was extended for 
FY '93-94. 

One of the goals of the project was to establish an advisory committee to assist the project 
in identifying and addressing barriers to adequate perinatal care. An African American Infant 
Health Advisory Committee composed of 24 members was convened. Included on the 
committee are community leaders, health professionals, educators, and parents. The Advisory 
Committee meets six times a year and serves as a coordinating body to ensure access to quality 
perinatal care for African American women, and survival of their infants, by promoting 
educational and referral programs within the City of Long Beach. 

This project identifies barriers to adequate perinatal care affecting African American women. 
Outreach and education are provided for the target population through a door-to-door campaign. 
Women are linked with pregnancy testing, prenatal care, WIC, childbirth education, and 
necessary support services. Mentor and transportation services are provided for African 
American women through subcontracts with the National Council of Negro Women and Alpha 
Kappa Alpha Sorority. 

The Black Infant Health Project in Long Beach has become a valuable resource in the City's 
efforts to decrease infant mortality. 



122 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health Department has actively pursued additional resources to address the 
problem of high African American infant mortality. The Department took the lead in establishing 
the African American Infant Health Advisory Committee. The City Health Officer served as the 
project director and acted as liaison with the African American community to ensure appropriate 
presentation in the Advisory Committee. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? This project allowed the Department to link with the African American community and 
establish a strong public-private partnership with the community resources, agencies, and 
leadership. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Medi-Cal Application 
Process/Systems Access 

How overcome? Women from the Black Infant 
Health Project are referred to the Perinatal 
Access Project. At this "one-stop" center, the 
women and their infants and children are 
provided with financial screening and assistance 
with medi-Cal applications, as well as risk 
assessment and referral to appropriate prenatal 
and pediatric providers. 



Barrier 2: Involvement of male partners in 
supporting the appropriate utilization of health 
care services by pregnant women and their 
infants. 



How overcome? The Health Department has 
successfully obtained an additional grant from 
the State of California Maternal Child Health 
Branch to address this barrier. 



5. How is it funded? MCH block grant funds. 

What is the approximate annual budget for this initiative? $136,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? The project's 
Scope of Work specifies the measurable objectives and specific data that need to be collected. 
These include maintaining copies of minutes of the meetings on file, submitting activity 
summaries, and surveying results, vital statistics, and mortality data in timely progress reports. 
In addition, summaries of subcontractors' performances are included in progress reports. 
Through the program, 343 high-risk African American women have been included and 
maintained in a network where they receive regular prenatal care, pregnancy-related health 
education, WIC services, and assistance with other psychosocial needs. The case finding, 
networking and coordinating function of the BIH program has played a major role in improving 
the rate of entry into prenatal care for African American women. 

6b. Has this initiative been formally evaluated? Yes. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? This initiative has been successfully implemented in 15 other counties in California. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? Sixteen counties in California. 



123 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Public Health Programs and Services 
Los Angeles, CA 

Irwin Silberman, MD 
213/240-8090 



CONTACT FOR MORE INFORMATION: Linda Velasquez, MD 



la. Initiative Name: Managed Care Planning Council 

1b. Category(ies) that best applies to your initiative: 

Strengthening Urban Public Health Systems - 40 Managed care initiatives 



Describe the initiative. L.A. County has a population of 9.1 million and the highest 
uninsured population rate in the nation, an estimated 3 million. More than one in four 
children in California (2.1 million) were uninsured in 1990. L.A. County Department of 
Health Services (DHS) operates six public hospitals, four of which have emergency rooms 
and three are level -1 trauma centers. In addition, DHS operates six comprehensive health 
centers and forty public health centers. DHS has an annual operating budget of over $2.25 
billion and in Fiscal Year 1992-1993, Med-Cal (Medicaid) was a source of 43% of the 
revenue. State-wide uncompensated care of 45.5% is provided in L.A. County and 80.2% 
of this is provided in County-operated facilities. 

With rising medical costs, and a shortfall of funds from the State, DHS began to transition 
to a managed care system. The State also moved to transition Medi-Cal recipients into 
managed care plans. L.A. County formed a health care consortium of public/private 
providers: the L.A. County Managed Care Planning Council with eight subcommittees. The 
subcommittee on Special Populations was to ensure that categorically funded programs 
servicing special populations would continue offering those same services to the patients. 
Children's health issues were given special attention with the formation of the Children's 
Health Consultant Committee. This committee made recommendations on the major 
children's programs: California Children's Services, Child Health and Disability Prevention 
Program (EPSDT), Regional Centers for Disabled Children, School-Linked Health Services, 
Special Education PL (94-142), and Foster Care among others. This exhaustive process is 
now at the stage of creating an interim governing body which will organize a permanent 
board to continue the work of the council. Providing child advocates with an opportunity 
to participate in this process assures the effective and efficient integration of child health 
programs and the quality of their health care. 



3a. In planning and Implementing this activity, what has been the leadership role of your health 
department? The Department of Health Services has been the leader in organizing, 
convening, and guiding the process. Senior management has been committed full-time. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? L.A. County DHS has taken a high profile activity and has been notable in 
including many private organizations in the process. 



124 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Communication. 

How overcome? Open meetings, frequent 
written evaluations, large mailing lists to keep 
all informed. 



Barrier 2: Dealing with a complicated 
disjointed health care system. 

How overcome? Frequent meetings, 
emphasizing shared goals, including everyone 
who expressed an interest. 



5. How is it funded? City/County/Local government funds; Private source: Participating local 
care providers. 



What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? The 
measurable objectives of this on-going project will include those currently used to assess 
the needs of the community. 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? There are 10 other counties in California working on similar plans. However, 
comparisons are difficult due to Los Angeles County's large size. 



7b. Has this program been replicated elsewhere? N/A. 
If yes, where? 



125 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CItyMatCH CONTACT: 
TELEPHONE: 



Jefferson County Health Department 
Louisville, KY 

Leslie Lawson 
502/574-6661 



CONTACT FOR MORE INFORMATION: Anita Black 



la. Initiative Name: The Neighborhood Place 

1b. Category(ies) that best applies to your initiative: 

Improving Access to Care - 30 One-stop shopping, co-location of services 



Describe the initiative. Seven agencies are working together in one location to provide 
accessible and responsive services that support the target community, families and 
individuals in their progress toward self sufficiency. To enhance education, health, 
employment and other opportunities for success the following public and private agencies 
have dedicated staff and resources to the Neighborhood Place: Jefferson County Health 
Department, Jefferson County Department of Human Services, Jefferson County Public 
Schools, Private Industry Council, Cabinet for Human Resources, Department of Social 
Services, and Department of Social Insurance, and Seven Counties Services. Services 
provided on site include child health preventive examinations; immunizations; WIC; family 
financial assistance; assessments for mental health, chemical dependency and classroom 
behavior; and screening/referral for employment/training. Neighborhood Place which 
opened November 30, 1993, is housed in a dedicated area of a public middle school. The 
staff works together to place clients in all eligible services. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Representatives of the Health Department staff have been involved in the 
planning of the Neighborhood Place from it's inception. The staff from all agencies 
dedicated to work at Neighborhood Place began meeting six months before opening in order 
to become a team. Jefferson County Government (The Health Department is a county 
agency) has taken a lead role in developing and supporting this model. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes, by collaborating with the other six agencies involved in the leadership of the 
Health Department has become knowledgeable of other service agencies. Also, other 
community services providers are better informed about Health Department services and 
are making more referrals for care. Plans are being made to expand this one-stop service 
delivery model to other areas in the city. 



126 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Multiple agencies coming together 
with seven Individual personnel policies. 

How overcome? A strong collaborative 
effort among agency heads resulted in the 
employees becoming one staff. An on-site 
supervisor for day-to-day operation of the 
center was established. An agreement on 
common work hours, holidays etc. was 
established. 



Barrier 2: All seven agencies have different 
assessment forms for intake resulting In the 
client answering the same questions for each 
agency. 

How overcome? A single assessment/intake 
form to satisfy each agency's requirements 
was developed, and Is now being used along 
with a common release of information form to 
share data with participating agencies. This 
manual system will be computerized in the 
future resulting In an electronic centralized file. 



How is it funded? CIty/County/Local government funds; General state funds; MCH block 
grant funds; Other Federal funds; Private sources: Neighborhood Companies; Third party 
reimbursement (Medicaid, Insurance). 



What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? The 
Health Department portion of the Neighborhood Place has developed measurable objectives 
for WIC, Child Health and Immunization. The Neighborhood Place Is In the process of 
developing a computerized data collection system that will evaluate the program and 
provide measurable outcomes. 

Most clients who come to Neighborhood Place for one service, leave the center having 
received multiple services. For example, a family may be seen for emergency help with 
light and gas bill, the Department of Human Services would help with this problem and 
before the family leaves will have applied for food stamps, received needed Immunizations, 
enrolled in WIC and signed up for employment assistance. The Health Department's staff 
Involvement with Child Protective Service cases has helped the Center's clients in reducing 
the abusive pattern of behavior. 

6b. Has this initiative been formally evaluated? Each agency provides it's own quality 

assurance activities. It will be evaluated In the future. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Planning has begun to replicate the Neighborhood Place in another part of the city. 
The community center offers a majority of agencies available to the residents of that 
community. Individuals needing services would come to one site and without duplication or 
excessive travel access needed services. 



7b. Has this program been replicated elsewhere? No. 
if yes, where? 



127 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Madison Department of Public Health 
Madison, Wl 



CityMatCH CONTACT: 
TELEPHONE: 



Mary Bradley 
608/246-4516 



CONTACT FOR MORE INFORMATION: Dolly Marsh 



la. Initiative Name: Dane County Vaccinate Infants Promptly (VIP) Project 

1b. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 

Improving Access to Care - 26 Expanding private sector linkages; 32 Other outreach activities 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships; 43 

Immunization tracking, recall systems 



2. Describe the initiative. The goal of the CIP project, a joint effort of the Madison and Dane 

County Health Departments, is to improve the immunization status of children birth to 2 years of 
age (90% fully immunized by 1996). 

A coalition of public and private health care and social service providers, educators, business 
leaders, community groups and volunteers has assisted in the project design and 
implementation. 

Outreach strategies were developed, including door-to-door contact in targeted 
neighborhoods, computer recall, and teaming with McDonalds to print placemats with the 
names/phone numbers of every public health department immunization clinic in the state. 

Incentives includes coupons and treats from restaurants and stores, local food products 
(Oscar Mayer hot dogsl), coloring books and crayons, refrigerator magnets, and thermometers. 
Celebrities such as Ronald McDonald and University of Wisconsin Basketball Coach Stu Jackson 
('SHOTS WITH STU") helped to draw families in. 

To reduce barriers to service, immunizations were provided at different times (including 
evenings) and various new sites such as homeless shelters, methodone clinics, WIC sites, 
neighborhood centers and even the Chuck E. Cheese Restaurant. 

Collaboration with providers such as school districtis. Head Start, United Way, March of 
Dimes, hospitals, private clinics, and the media has increased awareness and attendance at 
clinics. A packet of updated information and guidelines was developed and distributed to all 
providers in an effort to standardize immunization practice. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Madison Department of Public Health has been the lead agency for the VIP 
Project. MDPH's annual work plan established a Steering Committee as well as the Technology, 
Education/Outreach, Evaluation, and Immunization Practices Workgroups. MDPH also organized 
and facilitated the Dane County Immunization Coalition. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Yes, the leadership of the health department has been enhanced as a result of the VIP 
Project. Many of the outreach strategies and collaborative efforts, including the 
coalition-building activities of the project, have become models for other initiatives within the 
department as well as outside the department. 



128 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Lack of experience and consistency in 
media relations. 

How overcome? In order to increase comfort in 
media relations, as well as consistency of 
information provided, a practice media plan was 
developed with important information about the 
project and upcoming activities that was to be 
used by all staff at each media contact. 
National Immunization PSAs and 
announcements were utilized, as well. 



Barrier 2: Delays in the development of the 
computerized immunization database software 
(MAD VACS), systems adjustment and servicing 
of hardware. 

How overcome? Consultation with a computer 
programmer outside the department, as well as 
the State Regional Immunization staff, 
supplement the department's internal 
programming capabilities. 



5. How is it funded? City /County /Local government funds; Centers for Disease Control (CDC). 
What is the approximate annual budget for this initiative? $121,876 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? See major 
accomplishments described in question 2. Other objectives: 1) Determine baseline 
immunization levels of county's children. A Retrospective Audit of kindergarten immunization 
records provided data and will be done annually. 2) Increase overall number of immunizations, 
with at least a 6% increase in DTP #4. Records indicate a 30% increase in the total number of 
immunizations of DTP #4. 3) Develop and implement a county-wide immunization registry with 
tracking system and record database that is accessible to all providers, both public and private. 

6b. Has this initiative been formally evaluated? Yes. See 6a. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes, 
this initiative could be implemented elsewhere. 

Why? The computerized immunization software is now available at no cost to all public health 
agencies in Wisconsin. Approximately 70 similar initiatives with funding from CDC are occurring 
nation-wide. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? See 7a. 



129 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Memphis and Shelby County Health Department 
Memphis, TN 

Brenda Coulehan 
901/576-7888 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Campaign For Healthier Babies 

1b. Category(ies) that best apply to your initiative: 
Prenatal Health - 04 Prenatal care 

Improving Access to Care - 32 Other outreach activities 
Other Outreach - 23.3 Adult education 



Describe the initiative. Developed in conjunction with Arkansas Department of Health 
replicating their successful model. Because of contiguity of states, population in E. 
Arkansas is exposed to Memphis media and tends to use many Memphis health facilities. 
Campaign For Healthier Babies consists of a media campaign and the Happy Baby Birthday 
Book - an educational book with coupons which can be redeemed when stamped by the 
provider on the appropriate dates. Coupons are dated to correspond with appropriate 
antepartal/postpartal and well child visits. Brochures in attractive stands have been 
distributed to private and community health providers. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Took the lead and maintained it with assistance of dedicated people from 
Arkansas. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes - seen as taking a proactive role when media spots are in a (more) prime 
time than our usual PSA's. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Financing - Both for Production and 
for Discount. 

How overcome? Persistence and patience on 
the part of several people. 



Barrier 2: Persuading private providers to 
display brochures and to participate. 

How overcome? Again - persistence and 
patience on the part of outreach manager. 



5. How is it funded? City/County/Local government funds, Private sourcels): Specify: March 
of Dimes, 2 Local Private Hospitals, Other: Community Health Agency (State Funded 
Agency - Arkansas Department of Health). 

What is the approximate annual budget for this initiative? First year implementation = 
$300,000 



130 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? We are 
monitoring number of inquiries, number of booklets distributed, etc. However, it is too 
soon to measure effectiveness reentry into care and number of prenatal visits. Even when 
we can measure this, Tennessee's entry into Managed Care, January 1 994, will probably 
affect the first year evaluation. 

6b. Has this initiative been formally evaluated? No, not yet. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Because we replicated Arkansas' model. 

7b. Has this program been replicated elsewhere? Yes, In TN from Arkansas. 



131 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



City of Mesquite Health Department 
Mesquite, TX 

Susan Dirik 
214/613-0182 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Well Child Program 

1b. Category(ies) that best applies to your initiative: 

Child Health - 10 Immunization; 12 EPSDT/screenings; 13 Expanded child health services 



Describe the initiative. The most recent initiative for the Mesquite Public Health Clinic in 
the field of Maternal and Child Health was the establishment almost three years ago of the 
Well Child Program. 

Until recently the City of Mesquite Public Health clinic only offered immunization 
services two and one half days per week. Funded 100% by the city government, the 
program allowed for the health clinic to work at a monetary loss of $42,000 per year. 

The health clinic staff were reporting consistently that citizens were requesting well 
child examinations, PKU testing and weight checks for their children. At the same time, 
the health clinic was meeting all requested goals and had remaining funds to loose one half 
day per week as long as funding guidelines were not exceeded. Within less than a year, 
this block grant for approximately $127,000 was awarded. 

This grant allowed the health clinic to increase well child services to daily. Within one 
year of receiving the block grant, the number of children seen in the Well Child Program 
went up 41 %. Within the past year the numbers increased even further by some 34%. 
Research indicates that this program will serve more than 1000 children by the end of this 
fiscal year. 

Prior to the establishment of this health clinic, the City of Mesquite had only two 
pediatricians who accepted Medicaid assignment on EPSDT visits. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The health clinic falls under the auspices of the Environmental Health 
Departments for the city of Mesquite. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The health clinic upon receiving the block grant, was also awarded a continual 
funding contract from the Texas Department of Health within one year of the initial grant. 

Currently, the health clinic offers well child exams five days per week, and 
immunization services five days per week, two evenings and one Saturday per month. 
(Immunizations are also included as part of the well child screen). We were also able to 
drop all residential boundaries which were previously enforced. We were also able to begin 
accepting Medicaid in both programs. 



132 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Political issues at the county level. 

How overcome? Patience and time have 
slowly served to see these issues resolve 
themselves. 



Barrier 2: Pre-conceived notions about what a 
public health clinic is like. 

How overcome? Every effort is made to make 
the parent comfortable during the process. 
Plenty of time is allowed for one-on-one parent 
and nurse question and answer sessions 
during and after the examination. Every effort 
is made to offer a clean decent waiting area. 
Surveys are taken periodically to determine 
how we can better serve the families. 



5. How is it funded? City/County/local government funds; MCH block grant funds; and Third 
party reimbursement (Medicaid, insurance). 

What is the approximate annual budget for this initiative? $72,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Please see the attached data sheet to review how our patient load is charted. 



6b. Has this Initiative been formally evaluated? 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? I believe that community based clinics have a better chance at being able to address 
the needs of the people they are serving. Community, the term, should mean just that. 
County levels and districts are too large. Within one county just determine how many 
communities you have. I believe knowing the need of this community has been the 
greatest factor toward our success. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



133 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



HRS - Dade County Health Department 
Miami, PL 



CityMatCH CONTACT: 
TELEPHONE: 



Eleni D. Sfakianaki, MD, MSPH 
305/324-2401 



CONTACT FOR MORE INFORMATION: J. Rivera, RN, MSN 



la. Initiative Name: Low Literacy Childbirth Education Program 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 04 Prenatal care 

Improving Access to Care - 24 Overcoming racial/ethnic/language/cultural barriers 
Strengthening Urban Public Health Systems - 36 Staff training; 41 Building coalitions and 
partnerships 



2. Describe the initiative. As part of Florida's Healthy Start Program, which is a statewide 
initiative to improve birth outcomes, childbirth education was identified as a service that 
was desired but not available for the medically indigent clients. Our challenge was to 
prepare childbirth educators and offer childbirth education classes. In order to meet the 
socially and economically complex needs of the Dade County community, a comprehensive 
low literacy/culturally sensitive childbirth education curriculum was selected. Currently 
continuous classes are offered throughout the county at various sites. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Established a mechanism to make available: - childbirth educator training 
courses; - staff; - budget provision; - establishment of linkages in community; - equipment, 
physical facilities and support. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? N/A 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Lack of childbirth educators to 
teach medically indigent low literacy clients. 

How overcome? Internal recruitment of 
Public Health Department staff to develop 
interest in providing classes. 



Barrier 2: Space and location that clients 
could easily access. Security concerns. 

How overcome? Linked with 
County/University Hospital for site and 
utilization of county sites. Security was 
provided by contract. 



134 



5. How is it funded? General State funds. 

What Is the approximate annual budget for this initiative? $53,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the Initiative? What have been its major accomplishments to date? 
Yes. To improve pregnancy outcomes. Data : - Review of attendance records. - Review 
of labor and delivery records. - Review of breastfeeding practices, bonding and 
attachments. Accomplishments : - 32 six-week sessions per year are offered. - 18 
instructors have completed childbirth education training. - 80% compliance rate of 
participants. - Clients' evaluation of classes good to excellent. - Due to clients' 
satisfaction expansion of the program is being planned. 

6b. Has this initiative been formally evaluated? In progress. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Most urban communities have low literacy indigent populations. Utilization of a 
teaching curriculum similar to one implemented in Dade County could improve birth 
outcomes for populations at risk. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? Other counties in Florida and other states. 



135 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Milwaukee Health Department 
Milwaukee. Wl 



CityMatCH CONTACT: 
TELEPHONE: 



Elizabeth A. Zelazek 
414/286-3606 



CONTACT FOR MORE INFORMATION: Sharon Fialkowski (414/286-3616) 



la. Initiative Name: Client Tracking System 

1b. Categorylies) that best applies to your initiative: 

Strengthening Urban Public Health Systems - 42 Building MCH data capacity 



Describe the initiative. The Client Tracking System (CTS) is a PC-based automated service 
documentation record keeping system that effectively tracks clients. CTS provides for a 
historical picture of clients, families and groups with a major focus on high-risk mothers and 
infants. The automated record allows for family linkages, comprehensive care plans and 
quality monitoring of services, including immunization tracking and recall. Individual 
program modules enable the user to build a customized system. Through data collection 
and trend analysis, the system will enable the Health Department to target services to 
Milwaukee's community needs, define health indicators for use by program planners and 
evaluators and advocate for policy change. 

Integral to the implementation of CTS has been Milwaukee Health Department staff 
training, the adoption of the Omaha System of clinical documentation, and the building of 
coalitions and partnerships with local public health agencies. The Omaha System is the 
standard documentation system used within the department for recording of clinical 
activities. CTS incorporates this system in its client tracking efforts. The Milwaukee 
Health Department has taken leadership for the Southeastern Wisconsin Omaha System 
Interest Group, an ad hoc group that meets twice a year to network and share 
developments and implications for practice. In the process, local urban MCH local public 
health agencies review the CTS software and consensually agree on the CTS 
developments. Linkages have also been developed with the Wisconsin Health Department, 
linkage will interface with the Bureaus of Laboratories, Consumer Protection and 
Environmental Health, Vital Statistics, Administration, as well as special programs within 
the department. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? As above plus, the Milwaukee Health Department has designed the CTS 
system. It spent 13 years surveying the country for an appropriate document and tracking 
system. A local needs assessment was completed. Extensive inservicing in the use of the 
Omaha System Problem List and the interim implementation forms was undertaken with 
staff and community. The department has also assumed leadership in marketing of the 
effort statewide. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? 



136 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Lack of funding. 

How overcome? CTS started with a needs 
assessment that identified critical system 
capabilities and function. Continual budget 
requests have been submitted to meet the 
next phase(s) of the project. On-going 
evaluation and progress reports are in place 
to help assure continued high priority 
placement within the department's budget 
priorities. 



Barrier 2: Staff resistance to change. 

How overcome? Every two months an 
educational inservice is held with case reviews 
through the team meeting process. The 
Nursing Division's Continuous Quality 
Improvement Committee has developed 
protocols, procedures and support documents 
and forms to enable the system change. The 
department's Total Quality Improvement 
Initiative supports the project and is integral to 
service delivery. 



5. How is it funded? City/County/Local government funds. 

What is the approximate annual budget for this initiative? Start-up costs of $700,000. 
Annual budget projected to be 15% of start-up costs plus salaries (network administrator 
and other support staff). 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Positive responses of local public health agencies and conference presentation participants; 
Positive staff response and beginning changes in practice; Statewide interest in purchasing 
the finished product. 

6b. Has this initiative been formally evaluated? No 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? The CTS can be duplicated in other urban communities to support the assessment, 
assurance and policy development functions of public health. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



137 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Minneapolis Department of Health and Family Support 
Minneapolis, MN 



CityMatCH CONTACT: 
TELEPHONE: 



Ed Ehlinger 
612/673-2780 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Children, Adolescents, and Violence 

lb. Category(ies) that best applies to your initiative: 
Child Health - 14 Injury (including child abuse) 
Adolescent Health - 19 Violence prevention/youth-at-risk 
Strengthening Urban Public Health Systems - 42 Building MCH data capacity 



2. Describe the initiative. In response to the increasing public and media attention on violence in 
Minneapolis, the KIDSTAT program (Child Health Status Monitoring Program) developed a report 
on Children, Adolescents, and Violence. The purpose of the report was to provide: 1) a 
structure to assess violence in a community; 2) a set of indicators to measure violence; 3) 
infornnation on data sources; 4) a review of the gaps and limitations of the data; 5) an 
assessment of the level of violence as it pertains to children and adolescents in Minneapolis who 
are either perpetrators, victims, or witnesses of violence; and 6) information that could be used 
for the development of programs and policies focusing on the reduction and prevention of 
violence. 

Data were collected from existing data sets in a variety of places including vital records, the 
police department, the public schools, the department of human services, the park department, 
the Bureau of Alcohol, Tobacco and Firearms, etc. Drafts of the report were reviewed by 
numerous agencies and individuals in the community to assure accuracy of the data and 
community ownership of the report. The report was released in a highly orchestrated and 
publicized fashion to attract community attention and generate community discussion. Copies 
of the report have been widely distributed locally and state-wide and staff have been available 
for presentations at conferences and meetings. 

Follow-up activities have been initiated with the Hennepin County Prevention Center. Plans 
are to use the report to stimulate the development of Violence Prevention Coalition. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Minneapolis Department of Health and Family Support initiated the KIDSTAT 
program as part of its assessment and policy development roles. The issue of violence was 
chosen by the department and the entire report was written by staff of the KIDSTAT Program. 
Health Education staff were also instrumental in the release of the document which was well 
covered by the media. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? The Minneapolis Department of Health and Family Support received a great deal of public 
visibility with the release of the report "Children, Adolescent, and Violence." The report fit well 
with the Mayor's agenda and we have become more closely linked with her office because of 
this report. Other agencies in the community have been impressed with the quality of this 
report and have been calling the department for additional information and for consultation on 
issues related to violence and data collection. 



138 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Difficulty accessing data sources and 
finding consistent data sources. 

How overcome? Persistent effort by the author 
of the report with help from research assistants 
from the University of Minnesota helped to 
uncover the necessary data. Many of the 
inconsistencies in the data couldn't be resolved 
and those had to be acknowledged in the report. 
Since one of the purposes of the report was to 
identify the gaps in the data, this didn't detract 
from the report. 



Barrier 2: Assuring accuracy of the data. 

How overcome? As we reviewed the data it 
became evident that much of the data from 
several of the sources was inconsistent and 
inaccurate. This was resolved by constant 
iteration with the person supplying the data. 
When the person supplying the data realized that 
their name would be included as a reference, the 
accuracy of the data improved. 



5. How is it funded? City/County/Local government funds 

What is the approximate annual budget for this initiative? $20,000.00 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? The evaluation 
of this report consists of identifying what program and policy changes occur in the community 
relative to children, adolescents, and violence. To date the following have occurred: 

* the electronic and print media have provided extensive coverage of the report, 

* the media have used data from the publication in other articles/reports, 

* a local foundation has pledged money to anti-violence activities, 

* copies of the report have been sent to local foundations with a letter from the mayor 
suggesting that they focus some of their resources on violence reduction programs, 

* the Minnesota Public Health Association will use the report as the basis for proposing some 
legislation in the next legislative session, 

* the University of Minnesota College of Education used the report as the needs assessment 
for a grant application to develop an Associate of Arts degree in violence prevention, 

* the 4th Judicial courts were planning a community forum on family violence and have 
expanded the scope of their forum because of the report. 



6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? This 
report could be implemented elsewhere. 

Why? In fact, this type of report is one of the core functions that should be done by local public 
health agencies. This type of report could be done more easily now because many of the data 
sources have been identified. Violence is a major problem in most urban areas. This type of 
report would help make violence a public health issue and put the local health department in a 
leadership role. 

7b. Has this program been replicated elsewhere? 

If yes, where? 



139 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Missoula City/County Health Department 
Missoula, MT 



CityMatCH CONTACT: 
TELEPHONE: 



Carol Regel 
406/523-4750 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Immunization 0-2 Years 

1b. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 



2. Describe the initiative. In January 1992/1993, the Montana Department of Health & 
Environmental Sciences initiated a strategic planning session for counties in Montana 
regarding the immunization status of our children 0-2 years of age. The declining of 
up-to-date immunizations was evidence of a current system that was not effective in 
serving our children. The Initiative resulted in providing monies to our community for the 
promotion and enhancement of immunizations. The components addressed public 
awareness, tracking and surveillance, and increased the opportunities for immunizations. 

The Public Health Nurse initiated efforts to enhance public awareness. This included media 
efforts through PCA's Television/Radio interviews. Board of County Commissioners 
announced a Proclamation for Pre-School Immunization Week. The Neighborhood Public 
Health Nurses expanded the availability of immunizations in their neighborhood areas with 
extra clinics outside of the Health Department. Immunizations were offered at the local 
mall, Urban Indian Center, Head Start, Day Care Centers, YMCA, and Low Income Housing 
areas. 

Parents of all newborns in the County are notified with a reminder letter of immunizations 
due at 3 months, 5 months, 7 months, and 15 months. A computer tracking system is 
used to alert the clients already receiving immunizations at the Health Department of 
immunizations due. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health Department has been the lead agency in developing the 
collaborative effort with the local organizations and the local physicians. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? As the visibility of the Health Department has increased, the community has 
become more aware of the services that can be provided, and local organizations are 
volunteering to be a part of the effort. The local Kiwanis Group has been financially and 
physically supportive. Local homemakers are volunteering at the Western Montana Fair 
Immunization Booth and McDonalds is organizing a collaborative Public Awareness 
campaign. 



140 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Financial resources. 

How overcome? Granted monies - for the 
initiative to improve immunizations for 0-2 
years. 



Barrier 2: Community awareness and lack of 
collaboration with physicians. 

How overcome? PSA's, planned mini- 
workshops with physicians' offices. 
Strengthening interagency relationships. 



5. How is it funded? City/County/Local government funds; Other Federal funds. 
What is the approximate annual budget for this initiative? $200,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? By 
year 1996, the immunization levels for all Montana children will equal or exceed 90% fully 
immunized, with all recommended vaccines by age 2 years. Measurement of 
immunizations provided on-site by age and type of vaccination. Assessment of Day Care 
levels of immunizations. WIC immunization records at the beginning of the project and one 
year later. Number of notifications sent to parents of children who have received 
immunizations through the Health Department, but have not returned when the next 
immunization was due. Maintain the immunization reminder project for parents of newborn 
infants and continue with the telephone call at 7 months to determine immunization 
compliance. 



6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? The current trend of the Health Community will enable the project to be replicated. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? 



141 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Mobile County Health Department 
Mobile, AL 



CityMatCH CONTACT: 
TELEPHONE: 



Joe M. Dawsey 
205/690-8115 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Poor Pregnancy Outcome Review Team 

1b. Category(ies) that best applies to your initiative: 
Child Health - 07 Low birthweight/infant mortality 



Describe the initiative. In an effort to improve the quality of health care given to the 
pregnant women and young children of our community, the Mobile County Health 
Department Women's Center convened a Poor Pregnancy Outcome Review Team. The 
purpose of this multidisciplinary team is to identify trends or programmatic problems that 
negatively impact on pregnancy outcome. Proposed solutions to identified problems are 
discussed and appropriate follow-up is done. 

The review team consists of a nutritionist, social worker, perinatal coordinator, clinic 
administrator, preconceptional counselor, nursing supervisor, and a medical care provider. 
The team meets bimonthly for one hour to review the charts of maternity patients who 
have experienced a low birthweight delivery (less than 2,500 grams), fetal death, or infant 
death. Approximately 170 charts are reviewed with a summary of maternal and infant care 
events to review. Each case is discussed at the meeting with individual members providing 
insight according to their area of expertise as to the appropriateness of care that was 
given. 

This program has proved very beneficial in the improvement of patient care services 
offered. Efforts of the review team have resulted in many patient flow and programmatic 
changes within the existing clinic system as well as the initiation of many new patient care 
activities, all of which serve to enhance the level of quality health care provided to our 
patients. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health Department has been the leader in this initiative. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Program management for patient care has been enhanced. 



142 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Time lapse in getting information 
for chart review. 

How overcome? Get information directly 
from hospital where patient delivered for 
team review. 



Barrier 2: Arranging team meeting time. 

How overcome? Scheduling at a specific time 
every two weeks rather than on an as-needed 
basis. 



5. How is it funded? MCH block grant funds; Third party reimbursement (Medicaid, 
insurance). 

What Is the approximate annual budget for this initiative? No separate budget. 



6a. Does this MCH initiative have specific, measurable objectives? How Is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? The 
MCH initiative has the objective of helping reduce poor pregnancy outcome. This is a 
specific measurable objective. The data is collected on birth certificates and discharge 
summaries for team review. The major accomplishments to date include changing patient 
rotation so service area will not be missed such as WIC and Social Services. It is still too 
early to determine overall reductions in poor pregnancy outcomes. 



6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 
This initiative would work in other urban communities. 

Why? It is very easily implemented if different professions work together. Our most 
difficult job was getting the physician providers' commitment to attend the meetings. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



143 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Stanislaus County Health Department 
Modesto, CA 

Cleopathia L. Moore 
209/558-7400 



CONTACT FOR MORE INFORMATION: 



1a. initiative Name: Building Coalitions and Partnerships 

1b. Category(les) that best applies to your initiative: 
Prenatal Health - 04 Prenatal care 
Women's Health - 01 Preconception health promotion 



2. Describe the initiative. In 1991, the Stanislaus Minority Community Health Coalition was 
formed to plan, advocate and actively coordinate community involvement to allow various 
ethnic minority groups to identify their specific health care needs, resources, and to work 
with them and other health care providers with finding potential solutions associated with 
those identified health care needs. As a result, a door-to-door survey was carried out to 
assess needs identified by the community. These findings were articulated to the Board of 
Supervisors, media, providers of health care, as well as the State Department of Health. 
The Coalition has subsequently been included in health care planning for the community, 
with representation to the Children's Interagency Council, Managed Care Steering 
Committee, State Department of Health meetings and other forums that address health 
care needs in Stanislaus County. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health Department allowed the MCH Director to Chair the Coalition and 
attend State and local meetings, provided in-kind services, provided space for the initial 
open house of the Coalition and, where needed, supplies and use of equipment (computer), 
etc. 



3b. Has the leadership of the health department been enhanced as a result of this activity? 
so, why? Yes. The Health Department has taken a more active role in the community, 
been included in any meetings that have to deal with identifying or planning to meet the 
needs of the community, whether health related or not. The Department is considered 
expert in working with the community; obtaining community support and being able to 
articulate the problems, concerns, etc. of the community. 



If 



144 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Initially, keeping the momentum 
and interest of the coalition. 

How overcome? Presenting concerns, allowing 
the members to all actively participate in 
problem-solving. Writing for the grant which 
allowed more active participation and provided 
some direction. 



Barrier 2: Funding, establishing credibility in the 
community and among health care providers. 

How overcome? Again, through the grant 
awarded by the State Department of Health 
Services (7/92) we were able to obtain funding to 
start addressing our concerns through identifying 
those of the community. Through support of the 
local media, community organizations, the Public 
Health Department and Mental Health Department, 
the Coalition began to be recognized. The MCH 
consultant (State) allowed this activity to become 
one of the objectives for the MCH Block Grant. 



5. How is it funded? City/County/Local government funds; MCH block grant funds; Private sources: 
Omega Nu, Christ Unity Baptist Church, Sierra Foundation. 

What is the approximate annual budget for this initiative? $30-50,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? No. 

The initiative is evaluated by the inclusion of the Coalition in planning, assessing the needs of the 
community, how often our document is requested by those organizations seeking funding to meet the 
community needs and how often the Coalition is drawn upon to serve as a broker of services. 
Accomplishments: 1) Survey tool, completion and analysis of survey; 2) serve as representative to 
Children's Coordinating Council; 3) serve as chair to local Managed Care Committee on Multicultural 
Health; 4) received funding from Omega Nu 6/94 for purchase of a computer; 5) asked by Sierra 
Foundation to participate in urban grant to address needs of children 0-8 in our community; 6) the 
only Multicultural coalition of its kind in the State of California with representation from the Asian 
(Hmong, Lao, Cambodian), Afro-American, Caucasian and Hispanic communities. 



6b. Has this initiative been formally evaluated? Yes. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Whenever there is diversity of people with common concerns, specifically health 
care and social issues, a common bond is established. The only ingredient needed is 
perseverance and commitment. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



145 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Metropolitan Health Department of Nashville/Davidson County 
Nashville, TN 



CityMatCH CONTACT: 
TELEPHONE: 



Betty Thompson, RN 
615/340-5648 



CONTACT FOR MORE INFORMATION: Joan Clayton-Davis 



la. Initiative Name: Metropolitan Nashville Stroke Belt Initiative 

1b. Category(ies) that best applies to your initiative: 

Improving Access to Care - 27 Clergy and health connections 



Describe the initiative. The Stroke Belt Initiative is a community-based, risk factor reduction 

initiative designed to reduce stroke in the African American community of Nashville, Tennessee. 

The program is designed to 1) train a team of church members to work together effectively as a 

team; 2) plan, implement, and evaluate stroke related health promotion activities; 3) conduct risk 

reduction activities in the community; 4) assist in training other church-based health promotion 

teams; and 5) assist the public health department in finding ways to address health disparities in 

the African American population. Team training consists of six (6) training sessions, each 1-1/2 

to 2 hours held at a church location. Topics include: 

Session I Introduction to Stroke 

Session II Team Building 

Session III Meeting Management 

Session IV Community Resources and Healthy People 2000 Objectives 

Session V Planning Health Promotion Activities 

Session VI Implementing and Evaluating Health Promotion Activities 

Health department staff continue to meet with teams to provide technical support; assist 
them in becoming involved in community coalitions that focus on addressing health disparities 
in African Americans, and assist in using the media to publicize activities of the teams or to get 
risk reduction messages to the public. The key element of the Stroke Belt Initiative is the 
development of working partnerships with African American churches to address health issues. 
All activities are planned by the churches with support from the Metropolitan Health 
Department. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Metropolitan Health Department staff developed the training program, recruited 
participating churches, trained church based health promotion teams, and continue to provide 
technical assistance in the development, implementation and evaluation of stroke related 
activities held in the church or the communities they serve. Technical assistance examples 
include: 1) training health promotion team members to conduct training sessions for other 
churches; 2) developing and conducting a survey as part of a needs assessment; and 3) 
developing an intergenerational stop smoking campaign. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Leadership of the health department has gained invaluable insight into the process of 
developing effective partnerships with African American Churches as a vehicle for transmitting 
health care from the public health arena to targeted groups in the community, especially the 
African American community. 



146 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Identifying churches and church team 
members willing to make a long term 
commitment to health promotion in their church 
and community. 

How overcome? 1) Outlined roles and 
responsibility of each partner in the Stroke Belt 
Initiative and each church submitted a 
Participation Checklist to the health department. 
2) Involved church leaders in all aspects of the 
program from decisions to participate, selection 
of team leader and team members, selection of 
activities to implement, to approving needs 
assessment instrument (survey questionnaire) 
and how it would be conducted at the church, 
and how data would be presented back to the 
congregation. 



Barrier 2: Overcoming suspicions about African 
Americans being used for research only, rather 
than providing service to the community and 
suspicion about one time/short term projects. 

How overcome? 1) Spent 1-3 months in program 
development meetings with church leaders to 
ensure there was a clear understanding that the 
initiative rests on an ongoing equal partnership. 
2) Framework for establishing teams was built on 
the church assuming responsibility and a 
commitment to maintain the team as an ongoing 
aspect of its outreach efforts. 3) Ensure that the 
health department had as much background on 
each church as possible, especially past outreach 
efforts and community involvement of the pastor 
and other church leaders. 



5. How is it funded? City/County /Local government funds; Other Federal Funds - NHLBI. 
What is the approximate annual budget for this initiative? $31,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Objectives include 
training at least two (2) church-based health promotion teams who must conduct at least one (1) 
community activity each year. Data for planning activities is collected via a 14-question church 
member questionnaire that collects data on individual and family experience with stroke, high 
blood pressure, and diabetes, lifestyle issues, and knowledge about stroke and health disparities in 
African Americans. Three (3) teams have been trained in the first year of the program. More than 
300 individuals have completed church member surveys. A children's (intergenerational) stop 
smoking contest/campaign has been developed and implemented. Health promotion activities such 
as blood pressure screening, health fairs, nutrition seminars and walking clubs have been 
implemented or are planned. Three media stories have been aired and one newspaper article 
published in year one of the program. Teams evaluate each training session and an overall 
training. Activities are evaluated as conducted. 

6b. Has this initiative been formally evaluated? No 

7a. Do you think that this initiative would work if implemented in another urban community? This 
initiative could be replicated in other urban communities and can be instrumental in targeting 
special or at-risk populations. 

Why? The use of church-based teams can enhance efforts to address health problems that impact 
health disparities in African Americans or other ethnic groups. This approach can be implemented 
in small, medium size, or large church congregations utilizing volunteers who have health related 
backgrounds or no health backgrounds. 

7b. Has this program been replicated elsewhere? No 

If yes, where? 



147 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Newark Department Health and Human Services 
Newark, NJ 



CityMatCH CONTACT: 
TELEPHONE: 



Juanita Larkins 
210/733-7591 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: TB Task Force 

1b. Category(ies) that best applies to your initiative: 

Other Outreach - 22 Communicable diseases: STD, HIV/AIDS, TB, HepB 



Describe the initiative. The TB Task Force consists of health care providers from local area 
hospitals, the municipal, county and state health officers and other health care providers 
thought to be experts in the area of tuberculosis. The task force developed a survey and 
conducted surveys to collect data regarding the control measures which are currently in 
place for employees in our health care systems, schools inclusive of colleges and 
universities. Further the task force questioned the validity of available data and wanted to 
perform pilot studies on five (5) populations of individuals within our jurisdiction to replicate 
or dispute the available data. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Newark Health Department has functioned as the coordination point for 
activities conducted by the Task Force and has earned our two pilot TB screening projects. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? I'm not sure what this question is asking, however, the Health Department is 
perceived as now being interested in working with local hospitals to conquer this problem. 
The six hospitals in our community usually cannot all sit at the same table to discuss a 
common goal. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Getting all the players to come to 
the table. 

How overcome? The hospital CEO's were 
contacted via letter, telephone and in some 
instances in person. They were requested to 
assist in motivating their chief of pulmonary 
medicine to willingly join the task force. 



Barrier 2: Overcoming egos of each specialist. 

How overcome? All of the chiefs had 
difficulty bowing to each other. Each felt their 
method of operation was the only way to go. 
We assigned each chief an objective of the 
overall task force for which she/he was 
specifically responsible. 



148 



5. How is it funded? 

What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Yes!! Data is collected via reports, in some cases daily, weekly or monthly. 



6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? It is very flexible and can be tailored to suit any urban community. 

7b. Has this program been replicated elsewhere? I Don't Know. 

If yes, where? 



149 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



New Haven Health Department 
New Haven, CT 



CityMatCH CONTACT: 
TELEPHONE: 



Catherine S. Jackson 
203/777-5950 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: "First Steps to Healthy Child Development" 

lb. Category(ies) that best applies to your initiative: 
Prenatal Health - 06 Home visiting 
Child Health - 1 1 Early intervention/zero to three 

Improving Access to Care - 24 Overcoming racial/ethnic/language/cultural barriers, 33 
Increasing social support systems, 34 Case management/care coordination 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



2. Describe the initiative. "First Steps" serves working families with children in city daycare 
at the New Haven Child Development sites. The goal is to link daycare staff and clients 
with health care information and resources, and to ensure that each enrolled child is 
securely linked with a primary pediatric caregiver. Paraprofessional outreach workers based 
in the New Haven Health Department and in the City daycare agency provide family 
support services to families of children who may have medical, mental health or 
developmental problems. 

Major goals of the program are: 1 ) ACCESS TO HEALTH SERVICES: to ensure that Head 
Start and children of families transitioning from welfare into employment receive timely, 
regular and comprehensive health, mental health and developmental services; 2) ACCESS 
TO OTHER NEEDED SERVICES: to assist parents in securing other services (e.g. behavioral 
consultations, advocacy, housing) to promote healthy child development; 3) PARENT 
EDUCATION IN HEALTH & CHILD DEVELOPMENT: to communicate appropriate health 
education and child development information to parents of the above children in settings 
and in ways which will enable parents to make effective use of this information on behalf 
of their children. 



3a. in planning and implementing this activity, what has been the leadership role of your health 
department? The Health Department collaborates with the City daycare agency, Yale Child 
Study Center, Yale-New Haven Hospital, Hill Health Center and citywide Childcare Coalition 
to develop goals and objectives, job descriptions, workplans, training and supervision for 
the outreach/family support workers, provide education for families and monitor referrals. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The leadership of the health department has been enhanced in the following 
ways: 1) by expanding expertise of MCH home-visiting workers to child health issues 
beyond infant, 2) by demonstrating ability to collaborate with other agencies in planning, 
implementing, monitoring, and evaluating the new program. 



150 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Getting people from different programs 
to work together without turf battles. 

How overcome? Historically, none of the groups 
(health, daycare. Head Start, hospital and 
community health center) had worked together in 
an integrated way. The agencies involved had to 
develop a strong commitment to our shared goal 
(connecting families to resources) in order for this 
initiative to work. To tackle turf issues and 
bureaucratic idiosyncracies that obstructed 
progress required many meetings and continual 
networking and relationship-building across 
traditional agency boundaries. 



Barrier 2: Obtaining reliable health information on 
the children; poor communication between health 
providers and childcare providers. 

How overcome? We had to develop new common 
forms which would capture the information 
needed on the children and persuade (and train) all 
staff to use them routinely. 



5. How is it funded? City/County/Local government funds; Private sources: United Way/lnfoLine; 
Third Party reimbursement: Medicaid. 



What is the approximate annual budget for this initiative? $125,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Program objectives 
are: a) 90% of parents of enrolled children will attend the educational workshops and evaluate 
them positive; b) a minimum of 15 referrals to this program in year one, and 90% of referred 
children will be linked with needed services. The Childcare Coalition Project Coordinator records 
the numbers of parents attending workshops, numbers of referrals received and acted upon, and 
numbers of successful linkages. A team of Yale MPH students conducted a study comparing the 
charts of 223 enrolled children in initiative with 240 other New Haven Child Development children 
not enrolled in the First Steps program. This study showed that 24 Care Plans were developed in 
one year for the enrolled (experiment) group, versus seven Care Plans for the control group. Thus, 
77% of the total Care Plans that year were initiated by the group enrolled in First Steps, 
demonstrating that identification of health and developmental problems and of intervention was 
significantly greater with the outreach workers in place. 

6b. Has this initiative been formally evaluated? Yes. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? This initiative would certainly work in other urban communities, because working parents 
have new stressors from employment demands on their time and can benefit from the support of a 
child health educator/role model who provides family support. Both clients and staff benefit from 
collaborating. The staff of City Daycare became well-versed in health and mental health resources, 
learned when and how to refer children they previously considered behavioral problems, and 
witnessed the value of early mental health interventions by the Yale Child Study Center personnel. 
Medicaid payment was obtained for families whose children (still) qualified through an eligibility 
expansion (Healthy Start) even though the parent(s) were employed. In addition, hospital and 
health center personnel developed appreciation of city MCH workers' expertise. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



151 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



New York City Department of Health 
New York, NY 



CityMatCH CONTACT: 
TELEPHONE: 



Gary C. Butts, MD 
212/788-5331 



CONTACT FOR MORE INFORMATION: Carmen Ramos, MD 



la. Initiative Name: Community Interpreter Project 

lb. Category(ies) that best applies to your initiative: 

Prenatal Health - 04 Prenatal Care; 05 Expanding maternity services 



2. Describe the initiative. Over 28% of New York City residents are foreign-born, with one in 
five New Yorkers unable to communicate in English. Non-English speaking patients are less 
likely to access or effectively utilize available health services. Impacting on their health 
status and that of the community. Use of children, and other untrained bi-lingual 
individuals as interpreters may cross some linguistic barriers but has major implications 
including loss of detail and accuracy critical to medical/psychiatric interviews. 

In 1992, in response to the challenge of providing health services in a multilingual city, and 
understanding the impact on the community's health when this challenge is ignored or not 
adequately addressed, the Hunter College Center for the Study of Family Policy, in 
collaboration with the NYC Department of Health, NYC Health and Hospital Corp., and 
Bellevue Hospital Center established an innovative program which trains Hunter College 
bi-lingual undergraduates to be simultaneous medical interpreters. Students receive 
academic credit for interpretation training and for on-site interpretation at Bellevue and DOH 
Child Health Clinics. 

The Community Interpreter Project provides intensive training workshops and class sessions 
on which students hone their language skills, develop skill in consecutive and/or 
simultaneous interpretation, develop glossaries of medical terms, and discuss the delivery 
of health care and issues of immigration and settlement. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Bureau of Child Health conducted a survey of all 46 Child Health Clinics 
to determine the language spoken by clinic staff, and then worked with Hunter College in 
determining clinic assignments in order to match the clinic needs with the students' 
language and interpretive skills. We developed the glossary of medical terms used by the 
students in interpreting and participated in the orientation sessions on health care delivery 
given to students. The Bureau collaborated with Hunter College in designing and 
developing the grant proposal for funding of the project. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes, this project has enhanced cross-cultural sensitivity and increased awareness 
of linguistic diversity, and will thus help us in our ability to address health care concerns of 
our immigrant population. 



152 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Staff resistance and uncertainty 
about how to effctively use and integrate the 
student interpreter in the clinic operation. 

How overcome? By individual orientation 
and counselling of staff. 



Barrier 2: Insufficient number of families 
requiring interpretation during a clinic session 
to Iceep the student busy. 

How overcome? This problem was addressed 
by working with clinic receptionist to plan 
schedules so that non-English speaking 
families had appointments at the same time 
the students were assigned to the clinic. 



5. How is it funded? Other federal funds - Federal Department of Education Funds for the 
improvement of Post-Secondary Education (FIPSE); Private sources - Fund for the City of 
New York, New York Community Trust, Aaron Diamond Foundation, Starting this year - 
W.K. Kellog; Foundation, under the Division of Philanthrophy and Volunteerism. 

What is the approximate annual budget for this initiative? 1993 - $150,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Three targets of impact: 1 ) Students: Their interpretative skills, self-esteem and attitudes 
toward volunteerism; 2) Staff satisfaction; 3) Patient satisfaction. 

During the first year, 60 students provided 3500 hours of interpretation to New York City 
Department of Health Child Health clinics and selected health and hospital facilities. 

6b. Has this initiative been formally evaluated? Formative evaluation consisting of surveys of 
staff and student satisfaction were done the first year. Impact evaluation will be done this 
year. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? This program can serve as a model for replication because it demonstrates 
partnership and capacity building, and the ability to develop cooperation between a public 
health care agency and a teaching institution with tremendous student resource and 
diversity. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



153 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



New York City Department of Health 
New York, NY 



CityMatCH CONTACT: 
TELEPHONE: 



Gary Butts, MD 
212/788-5331 



CONTACT FOR MORE INFORMATION: Rose O'Keefe Block 



la. Initiative Name: New York City Child Health Plus Outreach Campaign 

1b. Categorydes) that best applies to your initiative: 
Child Health - 13 Expanded child health services 



2. Describe the initiative. In 1990, New York State enacted the Child Health Plus (CHP) program to 
provide health care coverage to the state's uninsured children for free or very low cost to parents. 
Because a large portion of the target population for the program resides m New York City, the state 
established the New York City Child Health Plus Outreach Campaign in 1992 to market and educate 
parents about the availability of the insurance. This Outreach Campaign has proven to be 
extraordinarily successful at enrolling children and reaching out to a diverse range of communities and 
cultures. Through an innovative approach of large-scale open houses, collaborative efforts with 
private insurance plans, and network building, the Campaign quickly met goals set by the state, while 
developing a highly responsive information and assistance system. 

In New York City, at least a quarter-million children have no health insurance. Most are poor and 
many are newly arrived immigrants and non-citizens. The Child Health Plus program covers these 
children for primary and preventive care services up until the age of 14. But reaching these children is 
a challenge given language barriers and distrust of public programs. 

The success of the Outreach Campaign where similar efforts have failed is direct result of its 
cooperative creative approach, which cuts across typical lines of government authority. For one, it is 
a truly collaborative project of the Medical and Health Research Association of NYC, Inc., the New 
York City Health Department (DOH), and the New York State Department of Health. More 
importantly, support is enlisted from private health plans, community-based organizations, foreign 
embassies, and other city agencies through extensive training of their staffs so they can also inform 
parents about the program. 

Another key component is the use of grassroots, outreach workers who conduct large-scale open 
house events in prioritized communities, using community-based organizations for translation 
assistance. The targeted communities were identified through a needs assessment in a marketing 
plan developed at the beginning of the Campaign. 



3a. In planning and implementing this activity, what has been the leadership role of your health 

department? Outreach efforts for Child Health Plus were facilitated through the DOH's leadership role 
in the professional community. DOH management linked the Outreach Campaign with their clinics 
and programs to reach poor working families and immigrants; NYS Department of Labor to reach 
recently unemployed families without COBRA benefits; NYC's Human Resource Administration (HRA) 
Medicaid insurance program to reach all children under age 14 who are rejected from Medicaid, hence 
eligible for Child Health Plus. Staff is currently working on their first linkage to a federal agency. 

3b. Has the leadership of the health department been enhanced as a result of this activity? if so, why? 
More than 30,000 children have been enrolled since CHP's inception which has reflected very 
positively on DOH. Enrollment has steadily increased, communities now believe this is a legitimate 
program rather than an insurance scam and more children are receiving preventive services. Child 
Health Plus represents DOH's commitment to new and innovative programs, its ability to keep pace 
with the changing face of health care and health care delivery to poor people. 



154 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : The greatest barrier faced was 
widespread skepticism of government social 
programs in high need communities. 

How overcome? Traveling under the banner of 
DOH, campaign staff forged an integrated network 
of neighborhood organizations, community 
activists, contracted health plans and immigrant 
advocates to promote Child Health Plus. 
Strategies include training these organizations to 
fill out applications, asking them to translate 
material into 8 different languages, distributing 
materials to parents regularly and co-hosting 
enrollment events. 



Barrier 2: Locating undocumented families and 
getting them to trust the people responsible for 
enrolling their children in Child Health Plus. 

How overcome? Strategies for overcoming this fear 
include using the community-based and immigrant 
advocate organizations to help staff explain the 
program to undocumented parents and stress that 
immigration status would not be affected; hiring bi- 
lingual and bi-cultural staff; producing information in 
8 languages; and asking each parent contacted to 
tell their families and friends about the program 
thereby capitalizing on word-of-mouth advertising. 



5. How is it funded? General state funds; Other: NYS Bad Debt and Charity Care Pool. 
What is the approximate annual budget for this initiative? $250,000 



6a. Does this iMCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? This initiative has 
specific objectives with data collected and reported in a monthly and quarterly narrative format 
measuring the number of: materials distributed citywide, CBO's and agency staff trainings, calls from 
parents to the bilingual hotline, meetings, professional trainings, presentations to parents and 
enrollment events. The major accomplishments to date are: Increasing citywide enrollment 70% by 
the third month of the Campaign's existence, creating the Child Health Plus language bank, co- 
sponsoring key events in the city geared to families with children under age 14, reducing the number 
of uninsured children depending on NYC DOH episodic care clinics and linking them to on-going 
primary care, developing linkages with public schools, Medicaid, the NYS Department of Labor and 
community based organizations to identify eligible children and enroll them in Child Health Plus. 

6b. Has this initiative been formally evaluated? Currently in progress. 

7a. Do you think that this initiative would work if implemented in another urban community? 

Why? The success of this initiative can be duplicated in other urban communities because it is 
explicitly built upon familiar as well as recognized multiple levels of organizational structures and 
resources which were then integrated into an informed and coordinated outreach plan by the staff of 
the campaign. 

7b. Has this program been replicated elsewhere? No 

if yes, where? 



155 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Norfolk Department of Public Health 
Norfolk, VA 



CityMatCH CONTACT: 
TELEPHONE: 



Joyce L. Bollard, RN 
804/683-2785 



CONTACT FOR MORE INFORMATION: Lisa Manley, MSW (804/531-2132) 



la. Initiative Name: Real Alternatives to Pregnancy (RAP) Program 

lb. Category(ies) that best applies to your initiative: 
Adolescent Health - 20 Teen pregnancy 



2. Describe the initiative. There are three (3) major components of the RAP Program: 

1) "Train the Trainer" and subsequent staff training for all youth serving agencies designed 
to target at-risk youth through a multi-agency, consistent community message regarding 
pregnancy prevention, sexually transmitted diseases, HIV/AIDS, prenatal care and parenting 
skills. This training was contracted out to a certified Sexuality Educator. 

2) RAP Program staff includes medical social workers and a public health nurse who are 
equipped with "beepers" so that the community (especially staff in youth serving agencies) 
have immediate access to them to facilitate education, consultation, counseling, and 
referral. Staff will visit anywhere in the community. 

3) RAP staff have done direct individual counseling to youth and families as well as group 
education such as "all night lock-in" groups in churches and recreation centers and with 
Youth Councils. Additional work has been done in coalition building. One example which 
promoted ownership of the program was accomplished through mini-initiatives where notice 
was sent out to community groups informing them if they wanted to do a program or 
project to foster teen pregnancy prevention, they could submit their plan for review and 
that eleven (1 1) projects for $1,000.00 each would be funded. There were many 
submitted and the eleven selected represented a wide perspective on dealing with teen 
pregnancy prevention. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The health department is an equal partner in the collaborative approach to 
solving community problems and is seen as the leader in providing population based public 
health services. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? Yes, fifty-four (54) community agencies or groups have been identified as referral 
sources to the RAP program and all have been contacted and the program marketed with 
referral mechanisms implemented. 



156 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Staffing due to use of part-time 
staff. 

How overcome? Hired full time staff with 
improved benefit package. 



Barrier 2: 

How overcome? 



5. How is It funded? General state funds; and Other - Matching state and local support. 
What is the approximate annual budget for this initiative? $190,000 per year 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Yes, both quantitative and qualitative evaluation of specific measurable objectives collected 
quarterly. Use of pre and post testing of youth serving professionals who are trained in the 
program. Approximately, 100 youth serving staff from over 20 agencies have been 
trained. There have been over 1,500 targeted youth individually counseled in the first year. 
Referral mechanisms implemented with 54 community agencies/groups. 

6b. Has this initiative been formally evaluated? Yes. Evaluation is on going by Virginia 
Commonwealth University, Research Center. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? However, it is absolutely necessary for the local community to determine that there 
is an agreed upon need and that the various parts of the community have collaborated and 
designed their unique approach to meet the need (within their community values, ideas, 
etc.). 



7b. Has this program been replicated elsewhere? No 
If yes, where? 



157 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: City County Health Department of Oklahoma City 

CITY/STATE: Oklahoma City, OK 

CityMatCH CONTACT: Loydene Cain, RN, Program Administrator Women's Health 

TELEPHONE: 405/425-4405 

CONTACT FOR MORE INFORMATION: 



la. initiative Name: Alcohol & Drug Abuse in Pregnancy-Prevention & Training (ADAPPT) 

lb. Category(ies) that best applies to your initiative: 

Prenatal Health - 08 Substance abuse prevention/treatment 



Describe the initiative. Through the development of a multilevel prevention and service coordination 
program, the project seeks to improve and expand services throughout the state to substance abusing 
women who are of childbearing age. The project will address the following three goals: 1) Promote 
the involvement and coordinated participation of multiple organizations in the delivery of 
comprehensive services for substance using pregnant women and their infants. 2) Increase 
availability and accessibility of prevention, early intervention and treatment services for low income 
women of childbearing age. 3) Improve the birth outcomes of women who use alcohol and other 
drugs during pregnancy and to increase the incidence of infants affected by maternal substance use. 

To achieve these goals there will be six categories of project activities: 1 ) Community 
Organization and Networking: a) Development of a community needs assessment and Task Force; b) 
Identification of gaps in services and barriers to care; c) Work to augment, enhance, or modify the 
services to better serve the needs of childbearing age women. 2) Within the Family Planning and 
Maternity Programs, pilot techniques to better identify the women with a substance use problem. 3) 
Outreach to identify and bring into care women with a substance use problem, who are not being 
served in the public health systems. 4) Case management services provided for one year after 
inpatient drug treatment or delivery of a drug exposed infant. 5) Professional's educational activities 
(instrumental to obtaining project goals); 6) Evaluation plan and sharing what learned. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? 1 ) Educator; 2) Developed and implemented community needs assessment; 3) 
Organized and coordinated community multi-disciplinary Task Force; 4) Developed and printed 
brochure concerning the service that was based on client input; 5) Obtained nationally known 
speakers that taught on the subject of Perinatal Substance Abuse; 6) Active participation in State 
Legislative committees who addressed legal and statutory concerns; 7) Assisted in development of 
new treatment centers and expansion of existing ones; served as consultant on advisory boards of 
treatment centers; 8) Organized Physician Panel discussion/presentation for health care professionals 
and students on Perinatal Substance Use issues; 9) Developed a Physician information Packet and 
mailed to all Obstetric and Family Practitioners; 10) Asked to participate on Fetal and Infant Mortality 
Analysis Review Board; 1 1) Via the Task Force, systems' level changes, in all participating agencies, 
introduced and implemented concerning priority to pregnant women. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, why? 

Yes. Successfully addressed the issue of perinatal substance use/abuse, demonstrated that we can 
be responsive and not just reactive to the needs of the community. Faced and addressed our fears by 
not being judgmental, we are better able to be there for our citizens. We proved that issues must be 
faced and not ignored. Opened the door for other "taboo" issues such as domestic violence. 
Exposed the community to the holistic health approach. 



158 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Access to clients for case management 
and follow-up difficult because of attitudes of 
professionals (stereotyping, judgmental, and fear) 
and Policies and Procedures that require referral 
(out of our clinics) of all "high risk" prenatals 
(including those women who ever had a history of 
substance use). 

How overcome? Education on the subject of 
Perinatal Substance Use/Abuse/Effects. 
Instrumental in getting the high-risk referral criteria 
changed (on a State level). 



Barrier 2: 
system. 



Our own agency (internal) accounting 



How overcome? Grant monies designated for direct 
client assistance, i.e., transportation, child care, 
emergency assistance, etc. Contracted with an 
outside, private, non-profit organization to 
implement; resulting in agency writing a check to 
the vendor and not the client. 



5. How is it funded? Other Federal funds - Office for Substance Abuse and Prevention 
What is the approximate annual budget for this initiative? $53,518.00 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Yes. Monthly referral 
log; Monthly monitoring of waiting lists of treatment centers; Reduction in Barriers Fund 
documentation; SASSI; POPRAS; Pre and post tests for curriculum; Preconception Health Appraisals. 

Major accomplishments are: Integrated into Maternity Services, entire staff trained, instrumental in 
obtaining more treatment centers for women and their minor children, State-Task Force on Perinatal 
Substance Use sponsored by State Legislators, overall entire community who serve women and 
children, giving priority to pregnant women and addressing issues of substance use. 

6b. Has this initiative been formally evaluated? Yes, Evaluated by Department of Mental Health and 
Substance Abuse Services Planning and Evaluation Division. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes 

Why? This project promotes the goals of most health departments, as it relates to improving the 
health of status of women and children in the community. The collaboration of professionals from 
different disciplines is an important element in the success of your project. 

7b. Has this program been replicated elsewhere? Yes 

if yes, where? Four sites in Oklahoma are Lawton, Tahlequah, Tulsa, and Oklahoma City. 



159 



1994 Urban MCH Leadership Conference Profile 



Describe your health departnnent's most successful recent initiative in the area of nnaternai and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Douglas County Health Department 
Omaha, NE 



CityMatCH CONTACT: 
TELEPHONE: 



Deborah Lutjen 
402/444-7209 



CONTACT FOR MORE INFORMATION: Magda G. Peck. ScD, PA, UNMC (402/559-5138) 



1a. Initiative Name: Omaha Maternal and Child Health Needs Assessment 

lb. Category(ies) that best applies to your initiative: 

Strengthening Urban Public Health Systems - 42 Building MCH data capacity; 39 Securing urban 
MCH technical assistance 



Describe the initiative. During FY '93 and FY '94, the Nebraska Department of Health, Maternal 
and Child Health Division, granted Title V funds to the University of Nebraska Medical Center to 
collect and analyze information on the health status of mothers and children in Douglas County. 
The project was designed to enhance local and state government capacity to monitor progress 
toward the Year 2000 Health Objectives. Valuable technical assistance to the Douglas County 
Health Department will enable the local health department to maintain the data collection 
responsibility. Reports from the project provide baseline data for MCH planning in Douglas 
County and serve as a template for future data reports. 

The Department of Preventive and Societal Medicine and the Section on Child Health Policy 
in the Department of Pediatrics analyzed socioeconomic, demographic, and health data from vital 
statistics, census, Medicaid, hospital discharge data, and some Health Department programs. 
This data is an important first step toward a comprehensive assessment of the unmet health 
needs of women, infants, children, and adolescents in Douglas County. 

Maternal and Child Health Status indicators will be linked with an inventory of maternal and 
child health services completed by the Douglas County Health Department. During the next 
year, a dissemination strategy will use the health services information and health status data to 
initiate community-based planning for maternal and child health. 

The Omaha Maternal and Child Health Needs Assessment project represents a collaborative 
effort between a local health department and an academic research institution. That 
collaboration enabled a local health department to fulfill its core public health function in 
assessing MCH needs. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Douglas County Health Department provided technical assistance during the 
entire data analysis project. Additionally, during the second year some data analysis was 
completed at the Health Department. A key responsibility was facilitating community 
representative participation in the process. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Initially, the UNMC "Omaha Needs Assessment" project was designed to enable the 
Health Department to continue and build on the baseline data project. Through the 
dissemination of these reports, the Douglas County Health Department will be positioned as the 
data source for maternal and child health status indicators and information. 



160 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Lack of a sentinel event (i.e., 
community MCH crisis) in the County that 
focused attention on MCH and development of 
partnerships in a comprehensive community 
response. 

How overcome? Data analyzed in this project 
and other population-based data projects \n\\\ be 
used as the sentinel event in our community. 
Information will be the "event" which captures 
the attention of the community and lead to 
commitments for action. Various population 
groups and community organizations have been 
included in the review and comment on the 
content and presentation of the data. 



Barrier 2: Duplication of current or planned 
population-based community health needs 
assessment. 

How overcome? The DCHD plans to collaborate 
with other community groups (e.g., hospitals, 
community-based organizations, and other data 
sources) to collectively disseminate data findings 
and collect community opinion on MCH needs 
and priorities. The DCHD intends to work 
cooperatively with other community sources in 
maintaining MCH health status indicators. 



5. How is it funded? City/County/Local government funds; MCH block grant funds; State funds. 

What is the approximate annual budget for this initiative? Title V $25,000; Other $30,000 (in- 
kind). 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? Yes, 
objectives were process objectives which established time lines and task responsibilities during 
the project. 

6b. Has this initiative been formally evaluated? Formal evaluation, No. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? Local health departments can greatly expand capacity through collaboration with existing 
technical resources in the community. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? The University of Illinois at Chicago, Division of Specialized Care for Children 
provides technical support to communities in Illinois. 



161 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Peoria City/County Health Department 
Peoria, IL 

Lise Jankowski, MS, RN 
309/679-6011 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Expanded Hours: WIC & Immunization 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 09 Breastfeeding/nutrition/WIC 
Child Health - 10 Immunization 
Improving Access to Care - 30 One-stop shopping, co-location of services 



Describe the initiative. Clinic nurses staff immunization and WIC clinics. Numerous 
problems were noted in both programs including limited physical space even after extensive 
remodeling, increased client demand, poor immunization compliance among preschoolers 
and IL Department of Public Health program requests to increase the WIC caseload by 800 
clients. Formal and informal program evaluations were done to assess WIC appointment 
showrates, immunization and WIC client requests and barriers to service. 

Input was sought from staff and management. A plan was developed and implemented in 
November 1993. As a four (4) month pilot project we: 1) Expanded hours of service for 
both programs: - Immunizations are offered by appointments. Monday 7-8a, 4-5p, and all 
day Friday. Walk-in clinics M&W 8:30-1 0:30a and 1-3p, and Th 8:30-1 0:30a are still 
available. - WIC also offered earlier morning appointments, as well as appointments from 
3-5p four (4) days/week. Expanded clinic from 3-4 days/week. 2) Used an early 
Childhood Education Center as an immunization site once/month to relieve congestion at 
the main office. This site is adjacent to a subsidized housing complex. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? This was a need that initiated with program staff and middle management 
based upon client/program needs. The Early Childhood Education Center offered space as a 
way to meet their students' and families' needs. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. Collaboration with the Early Childhood Education Center has opened the 
door for other community endeavors such as a Health Fair for school physicals. 



162 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Convincing administration to 
approve some radical changes in employee 
work hours in a unionized environment. 

How overcome? All data presented was 
client focused, although there were definite 
advantages to the employees who opted to 
work four (4) 10 hour days. 



Barrier 2: Resolving department policy 
questions for employees working four (4) 1 
hour days with respect to Holidays: How 
should employee be reimbursed? For a 48 
hour, 38 hour, or a 40 hour week? 

How overcome? Administration discussed 
with the union and reached a common 
understanding. This was then communicated 
to all staff involved. Policy was revised for 10 
hour/day employees. 



How is it funded? City/County/Local government funds. Other Federal funds: Medicaid, 
Title XX; Private Sources: fees for immunization for non-Medicaid; Third party 
reimbursement (Medicaid, insurance). 



What is the approximate annual budget for this initiative? WIC 
$305,000 (clinic income = fees, Medicheck, Title XX) 



$333,840; Immunization 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Yes. Collected data or showrates, number of Individuals served, employees' requests for 
time off/time used, medication errors and client complaints. Improvement was seen in all 
parameters except appointment showrates for WIC. Major accomplishments include : 1 ) 
increasing WIC caseload from 3200 to 4100 certified clients; 2) increasing number of 
children immunized; 3) decreasing employees' request for time off; 4) decreasing employee 
sick time; and, 5) increased flexibility in meeting client requests or to offer them choices of 
times, day, etc. With proper advertising of changes in service hours the numbers of clients 
served should continue to increase. 



6b. Has this initiative been formally evaluated? Yes. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes, very easily. 

Why? It requires a management-staff team willing to problem-solve creatively and with a 
willingness to change programs/service delivery as necessary to meet client 
needs/demands. 



7b. Has this program been replicated elsewhere? Don't know. 
If yes, where? 



163 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Philadelphia Health Department 
Philadelphia, PA 



CityMatCH CONTACT: 
TELEPHONE: 



Susan Lieberman 
215/685-6827 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: School Health Social Work Problem 

1b. Category(les) that best applies to your initiative: 

Child Health - 17 School-linked/school-based services 

Improving Access to Care - 29 Schools and health connections 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. This initiative is the product of the groundbreaking collaboration 
between the Office of Maternal and Child Health, Philadelphia Department of Public Health, 
and the School District of Philadelphia. Two social workers from the Office of Maternal and 
Child Health are stationed at two elementary schools in North Philadelphia, working in 
partnership with the school nurse to enhance the health and support services available to 
children from pre-school to grade 5. 

The social workers have three goals: 1) to enroll every uninsured child in a health 
insurance program; 2) to promote good health through workshops, health fairs and 
presentations to teachers, parents and neighboring community organizations; and 3) to 
provide intensive follow-up, through letters, phone contacts and home visits, to children 
who have not received basic health services due to parental inattention or neglect (for 
example, of 66 social work referrals at one site, more than half were for vision problems 
that often required eyeglass prescriptions). 

The schools are the Tanner Duckrey School and the Fairhill School. Both schools are 
comprised of low-income African American and/or Latino students with little community 
support and a multiplicity of poverty related disadvantages. In addition, cases of abuse 
and/or incest are not uncommon among the children, which requires the social workers to 
confront difficult psychosocial issues as well as medical and other practical challenges. 

During the summer month, the social workers are stationed at community sites that 
mirror the population and health care needs of their assigned schools. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Office of Maternal and Child Health conceptualized this project and 
initiated contact with the School District of Philadelphia to plan its execution. The project 
was devised specifically as a way of augmenting the Office of MCH's prenatal care 
program with services that would attend to the pressing needs of Philadelphia's children. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? Yes. The Office of Maternal and Child Health has been recognized by 
administrators, teachers and parents as a proactive unit of the Philadelphia Health 
Department. As a result of the project's success, plans are now underway to expand to 
two additional schools in the next year. 



164 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Many families live under extreme 
stress, which prevents them from taking a 
more active role in maintaining their children's 
health. 

How overcome? To combat this barrier, the 
principal at the Fairhill School established a 
computer training course for parents that 
included as one of its requirements that 
parents attend all health-related presentations 
offered by the school. Parents who met the 
requirements and went on to complete the 
computer course have found jobs as a result 
of their training. Other such "incentive" 
programs have been effective in increasing 
the involvement of parents in their children's 
health. 



Barrier 2: Collaboration between the school 
district and the Office of MCH has included a 
fair amount of "turf" wrangling. 

How overcome? Hands-on supervision by 
administrative staff has prevented the social 
workers from bearing the brunt of turf issues. 
In addition, both partner organizations have 
been extremely willing to respect the opinions 
and experience of their partner. Both 
organizations have kept in mind the inherent 
growing pains of any pilot project. Their 
success in overcoming this barrier has resulted 
in plans for the project's expansion in the next 
year. 



5. How Is It funded? MCH block grant funds. 

What is the approximate annual budget for this initiative? $65,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? 
Quarterly and annual reports to the Office of MCH indicate the success of this initiative at 
both sites. Data is recorded by two social workers, in partnership with the school nurse(s). 
Goals are set based on prior progress in meeting the project's three goals (see #2). One set 
of data is particularly illustrative of the project's success. Of 468 unresolved health 
problems at the Duckrey School, the school nurse was able to resolve 281 through phone 
contacts, letters, parent conferences and home visits. With the addition of the social 
worker, another 1 79 problems were resolved in similar fashion, bringing the total number of 
resolved problems to 460 - just eight shy of the total number reported. This result does 
credit to both the nurse and the social worker, and to the importance of their innovative 
teamwork. 

6b. Has this initiative been formally evaluated? No. 

7a. Do you think that this Initiative would work if implemented in another urban community? 
Yes. 

Why? There is nothing atypical about either the setting or the staff of the Duckrey and 
Fairhill schools. Collaborative working arrangements can be replicated elsewhere in 
communities where children of low-income families need enhanced health and social 
services. 



7b. Has this program been replicated elsewhere? No. 
If yes, where? 



165 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Maricopa County Department of Public Health Services 

CITY/STATE: Phoenix, AZ 

CityMatCH CONTACT: Melissa Selbst, MPH, CHES 

TELEPHONE: 602/506-6066 

CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Bridging the Gap - Pregnancy Outreach Program 

1b. Category(ies) that best applies to your initiative: 

Prenatal Health - 04 Prenatal care; 05 Expanding maternity services; 06 Honne visiting; 07 Low 

birthweight/infant mortality 

Improving Access to Care - 34 Case management/care coordination 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. To bridge the gap between Maricopa County's Correctional Health, and 
Public Health systems, the Pregnancy Outreach Program, Correctional Health, Inmate Services, and 
the Sheriff's Office developed a cooperative education, medical and referral system. The goal is to 
insure continuity of prenatal care as the woman moves from incarceration to open society. The 
Pregnancy Outreach Program identified various target groups who typically have poor birth 
outcomes, often leading to extensive infant stays in the newborn intensive care unit, and requiring 
many other special services. Pregnant women who are incarcerated at county jails and who would 
be released during pregnancy fit solidly into this category. With the "Bridging the Gap" program, 
the cooperative system begins meeting the needs of the pregnant woman while she is in the 
correctional system by providing program services within the correctional facility. These services 
include the Pregnancy Outreach Program's 12 week prenatal classes as well as individual intake 
and counseling sessions. Correctional Health continues to provide medical care. When a pregnant 
woman is released, Correctional Health notifies the Pregnancy Outreach Program so it may 
continue assisting the woman with her prenatal care and related health and social services that she 
may not have the resources to obtain. The Outreach worker follows the woman through the time 
of delivery, assisting her to make the transition to parenthood and offering the baby the 
opportunity for a healthy start in life. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Pregnancy Outreach Program initiated contact with the correctional system. 
Beginning a series of twelve 2 hour perinatal education classes, the POP then offered one on one 
counseling. The Department of Corrections became supportive of the program and began to 
cooperate with the POP on such issues as TB and STD screening, as well as clothing exchanges 
and notification of inmate release. This is the only program which links incarcerated women back 
into the community beginning during their jail stay and continuing after their release from prison. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 

why? The Pregnancy Outreach Program has been asked to present information on this program to 
various groups. This has been a visible way of meeting the needs of high risk maternity clients. 



166 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Rules and regulations of the Sheriff's 
Department Correctional facilities, e.g. 
lock-downs, scheduling conflicts, changes in food 
services, limited client-initiated access to the 
counselor. 

How overcome? Lock-downs - call ahead each 
time. Scheduling - accommodate for both group 
and individual projects. Coordinate activities with 
times when women are scheduled in the medical 
facility. Changes in staff/facilitv - request to be 
informed of changes. Meet with the new 
officers. Changes in food service - In flux. 
Sometimes nutrition is adequate, with food 
supplements available, other times questionable. 
Check with medical personnel for orders. Limited 
client access to counselor - Accept collect calls 
from clients. 



Barrier 2: Lack of success at securing additional 
funding for this program. 

How overcome? Our department is committed to 
continue this program with a half-time counselor. 
To prioritize her services, she utilizes her one on 
one counseling sessions to assess risk factors, 
along with noting which clients are due for release 
within the near future. When clients are released, 
she utilizes other staff and community resources 
as available. 



5. How is it funded? City/County/Local governmental funds; Private sources - Various organizations 
have donated baby items, food. 

What is the approximate annual budget for this initiative? $16,000 for 0.5 FTE and $1,000 for 

education materials. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Case-client forms 
are filled in on all clients and entered into a database. Class attendance is monitored. Progress is 
measured against the educational and program objectives, noting that written tests are threatening 
to many of these women; verbal and behavioral changes are noted, e.g.. improved fluid intake, as 
noted by physician, more accurate inmate records of fetal movement. Preliminary studies indicate 
that during 1993, less than 2% of the POP clients returned to jail. The rate of low birth weight 
babies was only 2%. Correctional health staff members report that, "Our patients are becoming 
wiser and more confident health care consumers... and they share the healthy messages with their 
non-pregnant roommates." Further studies are planned to look at birth weights, recidivism, job 
training and education on release, use of family planning, and infant immunizations. 

6b. Has this initiative been formally evaluated? The next stage of evaluation will pull together the data 
listed above. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? As long as there is rapport developed with the Corrections System, leading to a supportive 
relationship. There also needs to be a willingness to either use the current staff or share the cost 
of increased staff with the Corrections System. 

7b. Has this program been replicated elsewhere? It a similar program exists, we would be interested in 
dialoguing with them. 

If yes, where? 



167 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: Allegheny County Health Department 

CITY/STATE: Pittsburgh, PA 



CityMatCH CONTACT: 
TELEPHONE: 



Virginia Bowman 
412/355-5949 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Primary Care Partnerships 

1b. Category(ies) that best applies to your initiative: 

Child Health - 12 EPSDT/screenings; 13 Expanded child health services 

Improving Access to Care - 25 Reducing transportation barriers; 26 Expanding private 

sector linkages; 30 One-stop shopping, co-location of services 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



2. Describe the initiative. In preparation for managed care, the Department has consolidated 
its well-baby clinics and is converting them to primary care centers. This is accomplished 
by developing partnerships with primary care providers located near our continuing clinics. 
Partners include a federally funded community health center and area hospitals. Models 
vary by community and partner. 

In general, the Department brings to the partnership a caseload and staff who are 
experienced and skilled in serving families in their home communities. We are contributing 
clerical, nursing assistant and public health nursing services which are deployed to enhance 
primary care. This includes participating in the provision of primary care, enhancing 
educational services at the primary care sites, or home visiting to assess high risk families 
and assist in implementing the care plan developed with the family at the clinic. Our 
partners contribute experience in providing primary care with twenty-four-hour coverage. 
They bring the medical component and billing experience. 

The result is expanded and less fragmented care for children and families in their own 
neighborhoods or nearby. WIC and dental care are among the services co-located at the 
primary care sites. Some sites have a variety of family support services as well. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Department approached our partners and has provided leadership in all 
planning activities. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? These partnerships have enhanced the Department's leadership through 
relationships with major primary care providers and as a result of anticipating and preparing 
for change in the health care system. 



168 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Effective partnerships require much 
hard woric over a long period of time. Staff at 
all levels must be involved. 

How overcome? There is strong support for 
this initiative from the Director and Deputy 
Director. It is a priority for the Department 
and the Bureau. 



Barrier 2: Resistance to change is usually a 
barrier especially for an initiative like this; 
some staff perceived it as a loss of direct 
service under our control rather than an 
enhancement of service. 

How overcome? We are still working on this 
barrier by repeatedly presenting the vision to 
staff, involving them in the planning process, 
discussing their concerns, and demonstrating 
even small successes. 



How is it funded? City/County/Local government funds; MCH block grant funds; and Third 
party reimbursement (Medicaid, insurance). 

What is the approximate annual budget for this initiative? $275,448 is the Department's 
approximate contribution for the two existing centers. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Data is collected at the primary care centers and reviewed regularly by the partners. Two 
partnership centers are open and providing primary care for all ages. Three additional 
centers are currently being planned with three different partners; at least two of these will 
be pediatric primary care centers initially. 

6b. Has this initiative been formally evaluated? No 

7a. Do you think that this Initiative would work if implemented in another urban community? 
This initiative should work in another community 

Why? If the key elements for collaboration exist: common mission, powerful and skilled 
leadership, complete and uniform understanding, mutual respect and trust, true reciprocity 
of program ownership, sincere commitment, meaningful incentives, constant 
communication, and sufficient resources. 

7b. Has this program been replicated elsewhere? Unknown 

If yes, where? 



169 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: City of Portland Public Health Division 

CITY/STATE: Portland, ME 

CityMatCH CONTACT: Meredith L. Tipton, MPH 

TELEPHONE: 207/874-8784 

CONTACT FOR MORE INFORMATION: Layne Gregory, LMSW 



1a. Initiative Name: Family Violence Collaborative 

lb. Categorydes) that best applies to your initiative: 

Other - Not Elsewhere Listed - 45 All other not elsewhere classified 



2. Describe the initiative. After 6 months of intensive data gathering an invited group of 55 
individuals, representing 35 diverse community providers, came together to address the 
issues surrounding family violence in our community. 

Membership comes from the Juvenile Justice System, churces, schools, human service 
providers, business, media, mental health and substance abuse agencies, housing 
providers, recreation programs, hospital, medical community, police, legal system, shelter 
provider and public health. Our goal is to work toward the development of a responsive 
system that will lead to the elimination of family violence in our community. Action steps : 
1) develop resource manual; 2) collect and analyze secondary data; 3) initiate subjective 
needs assessment survey among providers and present findings; 4) initiate consumer 
survey and present findings; 5) identify areas of common purpose based on the data; 6) 
define collaborative primary areas and work projects; 7) convene work groups and develop 
strategies, interventions and solutions; 8) develop agenda for full collaborative; 9) take 
steps to assure the identified system changes; and, 10) evaluate. 

This collaborative addresses all aspects of family violence whether it be child, spouse or 
elderly. Staff began work on this collaborative in January, 1994. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? 1) Conceived the idea, after analyzing data that supported the need to. 2) 
Hired staff. 3) Consulted with all participants of the family violence system. 4) Convened 
collaborative. 5) Published up-to-date resource guide for system users. 6) Have become 
repository of current secondary data on violence. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Tremendously so! The diverse membership were unfamiliar with the "steering 
role" of the Health Department. The understanding and awareness of this core function is 
better understood than at any other time. The Health Department was applauded for this 
effort. 



170 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Finding the financial resources to 
support the effort. 

How overcome? Identified cost savings from 
other programs and excess revenues to be 
dedicated to this project. This is a big area of 
concern from the political and city leadership. 



Barrier 2: Unavailability of city specific data. 

How overcome? We're working with a data 
guru to work the numbers for our community. 



5. How is it funded? City/County/Local government funds. 

What Is the approximate annual budget for this initiative? $30,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Evaluation is based upon how well we meet our objectives as agreed upon by the entire 
collaborative. The objectives are all measurable and easily tracked through the workplan. 
Data is collected by the collaborative staff in cooperation with the members. Major 
accomplishments: 1 ) publication of a resource directory; 2) presentation of secondary data 
findings; and, 3) dissemination of survey for subjective assessment of providers. 



6b. Has this Initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Collaboratives are highly regarded as successful mechanisms that contribute to 
needed systems changes. 

7b. Has this program been replicated elsewhere? Unknown, probably no. 

If yes, where? 



171 



._.j 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Multnomah County Health Division 
Portland, OR 

Mary Lou Hennrich 
(503) 494-1827 



CONTACT FOR MORE INFORMATION: Karen Lamica (503/248-3674) 



la. Initiative Name: Connections Program for Young Parents 

1b. Category(ies) that best applies to your initiative: 
Adolescent Health - 21 Teen parenting 



Describe the initiative. 

/. Outreach and Assessment: Community Health Nurses in hospitals, clinics, and in the 

field, identify teen parents prenatally, at the point of delivery, or soon thereafter, and 

assess their needs and refer them to the program coordinator who makes subsequent 

referrals as needed. 

Method: CHNs visit hospitals, maternity units and work in conjuction with discharge 

planners to identify, assess and refer all teen mother and pregnant teens. Multi-service 

need clients are referred to Community-Based Agencies based on where they live. All teen 

parents interested in community health nursing services are referred to a field office for 

CHN services. Home visits, postpartum, well baby and/or developmental screening services 

may be provided. 

2. Contracted Agency Core Services: Multi-service need teens are referred to a 
Community-Based Agency for core services that consist of: 

a. Case Management 

b. Support Groups 

c. Parent Education 

d. Child Development 

e. Culturally Specific Services and Outreach 

3. System Coordination: Coordinator tracks data on clients and facilitates cooperation 
between associated agencies. Ongoing program evaluation is also a component of 
coordination. The coordinator also facilitates cooperation between agencies, funders and 
ancillary services to provide smooth delivery of services. The coordinator works with case 
managers and their supervisors when problems arise. To ensure system efficiency on all 
levels, the coordinator has access to the same computer system as Community Health 
Nurses and case managers. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? We have worked collaboratively with other funders, providers and consumers 
to develop and implement the service delivery model. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. Our ability to be flexible and collaborative in developing more effective teen 
parent services has resulted in increasing trust in our agency as a community leader. 
Working closely with the community in developing the initiative has also impacted our skills 
as leaders in gathering support, building consensus and dealing with conflict. 



172 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Implementing a completely new 
system and overseeing resistance to change. 

How overcome? Making decisions within a 
framework of ongoing TQI and allowing 
people time to adjust to the changes. 



Barrier 2: Dealing with the time it has taken 
to implement the computerized training 
system. 

How overcome? Patience and preparing as 
much as we can. 



5. 


How Is 


it funded? 


City/County/Local government funds. 










What is 


the approximate annual budget for this initiative? 


2.0 CHN, 


.5 PDS, 


$360,000 for 




service 













6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 

1. Yes 

2. The CHNs and Community-Based Agencies we contract with collect the data. 

3. Creating and Implementing the Initial intake form. 

4. Surpassing our original goal of visiting at least 70% of teen parents in the hospital. 

6b. Has this initiative been formally evaluated? No. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? We have overcome the barriers associated in dealing with a diverse group of 
providers and are beginning to reap the rewards (e.g., earlier intervention) of having 
providers of care collaborate with each other. 



7b. Has this program been replicated elsewhere? No. 
If yes, where? 



173 






1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Wake County Department of Health 
Raleigh, NC 

Peter Morris, MD, MPH 
919/250/4637 



CONTACT FOR MORE INFORMATION: Julia Smith (919/250/4637) 



1a. initiative Name: Hospital Alliance for School Health 

lb. Category(les) that best apply to your initiative: 

Adolescent Health - 1 8 School-linked/school-based services 

Improving Access to Care - 29 Schools and health connections; 34 Case management/care 

coordination 



2. Describe the initiative. The Hospital Alliance for School Health is a community funded and 
focused pilot program serving four elementary, one middle and one high school in inner 
city. Southeast Raleigh. Privately funded by the County's three local hospitals, the Alliance 
provides services to improve school performance and success of students in the targeted 
schools. 

Four school nurses are assigned one or two schools each, providing screening, referrals, 
consulting, and counseling to students, families and faculty. A school linked clinic, staffed 
by a clerk, nurse, and PA with physician consultation, provides clinical assessments. 
Nurses use case management skills for students or families requiring on going care, 
referring the most difficult cases to a full-time social worker. A part-time nutritionist 
counsels parents, teachers, and students and coordinates health fairs. Each school chose 
and implemented a health promotion initiative. 

Prior to the Alliance expansion, eleven school nurses were spread thin serving almost 
80,000 students in 94 schools. The alliance pilot program aims to prove the benefits of 
intensified school health intervention. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health Director serves as the President of the Hospital Alliance for 
community health, a 501(c)(3) corporation whose Board members represent the CEO's, 
Boards, and physician staff of three area hospitals. The Alliance board chose to fund this 
project from among a dozen proposed by the Department of Health staff. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Absolutely. The Department of Health by demonstrating initiative, planning and 
management is more highly regarded by private business and physicians in the community, 
and is credited with bringing private support to a community problem. 



174 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Redirecting efforts of school health 
nurses. 

How overcome? The purpose of the Alliance 
is to improve school performance, not simply 
increase access to health services. Nurses 
must consider which interventions will best 
improve grades, promotion, and graduation. 
Team meetings, workshops, evaluation, and 
redirection occurred monthly. 



Barrier 2: 
schools. 



Redefining school health to the 



How overcome? The Alliance does not staff 
sick rooms. Faculty meetings, one on one 
sessions with administrators and teachers, and 
constant reminders that school success was 
the focus - not distribution of tylenol - kept the 
schools on track. 



5. How is it funded? Private source(s): Private, nonprofit formed by area hospitals. Third 
party reimbursement (Medicaid, insurance). 

What Is the approximate annual budget for this initiative? $370,000/year (over $1 million 
committed over 3 years) 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? Both 
process and outcome data are collected to assess service delivery and school performance. 
Service data is collected per State requirements, with local and project modifications. 
School success is measured by changes in absenteeism, end of year grades, promotion 
rates, drop out rates, etc., provided by the schools. 

Over 45% of students were served year one; nearly 200 were case managed. Parent and 
teacher surveys noted improved grades and decreased absenteeism among students 
served. Formal statistical analysis of grades, promotions, etc. is underway. 



6b. Has this initiative been formally evaluated? Yes 



7a. Do you think that this initiative would work if implemented in another urban community? 
Possibly. 

Why? Every community needs to invent school health programs and services acceptable to 
that community. For some communities, this is school based clinics; for other 
communities, this is sick rooms. For Wake County, it means services to improve school 
performance. 



7b. Has this program been replicated elsewhere? No 



175 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Monroe County Health Department 
Rochester, NY 



CityMatCH CONTACT: 
TELEPHONE: 



Karin Duncan 
716/274-6192 



CONTACT FOR MORE INFORMATION: Patricia Sood 



la. Initiative Name: Breastfeeding Promotion Plan 

1b. Category(ies) that best applies to your initiative: 
Prenatal Health - 09 Breastfeeding/nutrition/WiC 



2. Describe the initiative. The purpose of this project is to increase the incidence and duration 
of breastfeeding among WIC participants. Our local agency is working to increase 
breastfeeding rates at hospital discharge from 28.6% to 35% by December 31, 1994. We 
would also like to increase the number of infants breastfed longer than eight weeks from 
20.5% to 25% by December 31, 1994. We have identified and recruited approximately 
150 WIC clients interested in applying for training as breastfeeding peer counselors. We 
have to date conducted two eight-week training sessions in breastfeeding management to 
prepare these volunteers for breastfeeding promotion and support activities at various 
locations throughout Monroe County. As of June 25, we will have trained 25 peer 
counselors. We are following a caseload of approximately 70 WIC prenatal clients, and our 
goal is to expand that to approximately 250 clients by the end of October, 1994. We 
currently have about 1700 women on the Monroe County WIC Program. So these 250 
clients represent about 15 percent of our prenatal caseload. We are noticing an increase in 
the number of teenagers and young adults breastfeeding successfully as we initiate 
outreach efforts with Healthy Moms, Young Mothers, and Threshold. 

Our breastfeeding promotion plan consists of three contacts with a breast-feeding mom 
prior to delivery with an option for her to attend a breastfeeding class prenatally if she 
desires. 

Breastfeeding women have four contacts in the postpartum period. These contacts are 
for encouragement, problem solving and education. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? In planning and implementing this activity, the Monroe County Health 
Department WIC Program has been networking with many health care providers and 
community agencies to provide experts in all areas of breastfeeding management for 
training of peer counselors and to identify community resources to ensure breastfeeding 
success for our WIC clients. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The leadership of the HD has been enhanced as a result of this activity because 
it has been an opportunity for myself, as a professional, to both learn more about 
breastfeeding and find out what resources are actually available within our community. 

There is plenty of opportunity in this position to be creative and try several approaches 
to problem solving to arrive at the desired agency goal. 



176 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Difficulty motivating Peer 
Counselors and keeping their interest once 
trained. 

How overcome? Developing creative 
projects for them to work on. Having 
monthly meetings which provide continuing 
education for them. Writing grants to provide 
motivational incentives. 



Barrier 2: Time has been a limiting factor 
(adequate time to meet the demands and 
education of Peer Counselors and clients). 



How overcome? Using time management 
skills: setting priorities, delegating 
responsibilities to others when possible. Using 
organizational skills to help the work flow. I 
am constantly reviewing and revising. 



5. How is it funded? Other: New York State Health Department funds. 
What is the approximate annual budget for this initiative? $60,000. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? We 
will be able to determine when agency goals have been met by reviewing computer- 
generated reports from the New York State Department of Health at the end of December. 
These reports will tell us the number of postpartum women breastfeeding at hospital 
discharge and length of breastfeeding in weeks. 

6b. Has this initiative been formally evaluated? No, not at this time. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Because breastfeeding moms usually recognize the need and are interested in 
helping other moms learn to breastfeed. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? Several projects within New York State and in other states also. 



177 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Marion County Health Department 
Salem, OR 



CityMatCH CONTACT: 
TELEPHONE: 



Donalda Dodson 
503/585-4977 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: North County Consortium 

1b. Category(ies) that best apply to your initiative: 
Prenatal Health - 04 Prenatal care 
Child Health - 13 Expanded child health services 
Other Outreach - 23.3 Adult education 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 
Other - Not Elsewhere Listed - 45 



Describe the initiative. Provides comprehensive and coordinated prenatal care to 100 low 
income pregnant women, parenting education to 40 families, well-child care to 100-200 
children and comprehensive health service advocacy to the enrolled families through a 
four-agency consortium. Emphasis is one reaching low income women in the Latino 
community. The emphasis is on improving and promoting easy access and 
comprehensiveness of service through a systematic provider approach, making a 
"community system," through a consortium. Efforts continue to cultivate, enlarging the 
consortium and increasing collaborative partnerships to include more community agencies 
and groups. 

Services are provided on a sliding fee scale with no one denied service if unable to pay. 
The focus is on the pregnant/post partum women and her children age three years and 
younger, yet realizing the entire family dynamics and needs impact that woman and her 
child. Outreach is available to assist clients' access to health and supplemental services as 
indicated. Extensive teaching is offered to assist clients in skills building so they can then 
access resources as they graduate. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health Department brought community players together to discuss the 
collaborative consortium service model and then took the lead in writing and development 
of the proposal. The Health Department continues to facilitate ongoing consortium 
planning, evaluation, and service meetings and as issues present, the Health Department 
negotiates the consortium resolution. 

3b. Has the leadership of the health department been enhanced as a result of this activity? if 
so, why? The Health Department leadership credibility has been enhanced, the Health 
Department is looked to for leadership and for assistance in influencing decision makers to 
look favorably on this project and other areas within the community as well. 



178 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Keeping a collaborative consortium 
alive with good participation. 

How overcome? Frequent dialogue and 
meetings. Keep the channels of thought and 
communication open. Discuss issues until 
resolved. 



Barrier 2: Retaining qualified bilingual, 
bicultural staff. 

How overcome? Rearrange staff from within 
the Department; recruit from within. 



5. How is it funded? General state funds. 

What is the approximate annual budget for this initiative? $132,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? D Yes. 

1 ) One hundred women will receive prenatal care early in pregnancy to six weeks post 
partum. 

2) One hundred women will have a service plan developed to assure attention to their 
comprehensive needs, the plan being reviewed periodically at the provider's regular 
meeting. 

3) One hundred children will receive well child physical assessment and follow-up 
following the accepted periodicity schedule. 

4) Forty families will attend parenting sessions of 10 weeks each. 

Data is collected using two information specific forms and entered into data system. 
Accomplishments: 100 women services and over 150 children seen and 40 families 
received parenting. 



6b. Has this initiative been formally evaluated? Yes 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Collaborative partner-shipping enhances services available and develops a stronger, 
more comprehensive service system for the client. 



7b. Has this program been replicated elsewhere? No 



179 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Salt Lake City, County Health Department 

CITY/STATE: Salt Lake City, UT 

CityMatCH CONTACT: Suzanne Kirkham 

TELEPHONE: 801/468-2726 

CONTACT FOR MORE INFORMATION: 



la. Initiative Name: 

lb. Category(ies) that best applies to your initiative: 

Prenatal Health - 04 Prenatal care, 05 Expanding maternity services 

Child Health - 13 Expanded child health services 

Improving Access to Care - 26 Expanding private sector linkages; 30 One-stop shopping, 

co-location of services; 35 Increasing access to Medicaid 



Describe the initiative. To increase prenatal services, provide a bridge between prenatal 
and well child services and increase well child services, a contractual agreement has been 
entered into with the University of Utah Departments of OB-GYN and Pediatrics. 

This agreement provides a OB attending and two residents three half days a week and a 
pediatric attending and two residents five days a week. These providers work along side 
our nurse practitioners to provide care to women and children. 

The hope is to bring a stronger university presence into a health department clinic. Provide 
24 hour coverage which we now lack and provide trainings for residents. This allows the 
nurse practitioners to benefit from more consultation on site. The ability to see more 
complicated women and children exists. Other services such as WIC, immunizations, an 
EPSDT outreach worker and a medicaid eligibility worker are available to families. The 
transition from prenatal to well child care happens under one roof. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The leadership role could be debated. The state Health Department pulled 
everyone together in the beginning. The original players also included community health 
centers who have also attempted to co-locate with the University. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. We have strengthened community ties and developed new working 
relationships. 



180 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Financial - how to finance the 
project adequately. 

How overcome? Haven't yet. 



Barrier 2: Meshing different philosophies such 
as services need to be provided regardless of 
ability to pay. 

How overcome? Haven't yet. 



5. How is it funded? City/County/Local government funds; MCH block grant funds; Third 
party reimbursement (Medicaid, insurance); University Funding. 

What Is the approximate annual budget for this Initiative? Not sure at this point. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? We 
began formally in July - one objective is to try to fund all of those activities. Data 
collection will be mostly financially based initially. 

6b. Has this initiative been formally evaluated? No 

7a. Do you think that this initiative would work if implemented in another urban community? 

Why? It can work as long as a strong commitment exists on all parties to provide services 
to underserved populations. 

7b. Has this program been replicated elsewhere? Don't know. 

If yes, where? 



181 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



County of San Diego Health Department 
San Diego, CA 

Nancy Bowen 
619/692-8808 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: 
Families 



Building Healthier Futures, Communities in Action for Children, Youth and 



1b. Category(ies) that best applies to your initiative: 

Strengthening Urban Public Health Systems - 37 Strategic planning for urban MCH 



Describe the initiative. The Vision of "Building Healthier Futures: A community of children, 
youth and their families who are healthy in body, mind and spirit." This plan is an 
innovative, county-wide effort to plan for and address the priority health needs of San 
Diego's communities. It was developed through an intensive, year-long planning process 
that involved our 300 public, community-based and business organizations as well as direct 
input from youth and families. Five major agencies representing the concerns of San 
Diego's children, youth and families sponsor the Strategic Plan: these include the Child 
Abuse Prevention Foundation, Children's Initiative, County of San Diego, San Diego Health 
Coalition for Children and Youth and the San Diego and Imperial Counties Regional Perinatal 
System. 

In keeping with our Vision, the Plan defines health in the broadest possible sense. It 
encompasses, for example, not only freedom from illness but also living in a safe and 
supportive neighborhood and possessing the reading and writing skills to complete school 
or obtain a job. Hence, the Plan is organized around eighteen major issues ranging from the 
prevention of tuberculosis to the promotion of family friendly business policies. Several 
Priority Actions are proposed for each Issue. Together, these Priority Actions represent a 
prevention-oriented and coordinated approach for addressing the Issues. 



3a. In planning and Implementing this activity, what has been the leadership role of your health 
department? We initiated the process and were instrumental to bringing on the other 
(private sector) partners. We have supplied (primarily through our Title V funds) most of 
the resources for staffing and facilitating the planning process. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. Many people have been discussing the need for: a) public/private 
partnerships; b) integration/collaboration; and c) government doing assessment, assurance 
and policy development. These needs have been addressed to a significant degree in a 
very tangible, reputable manner. The support for the process is very substantial and the 
critical role the Health Department has played is recognized. 



182 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : The perception if Government is 
involved in such a process, it will "take over" 
and the private sector will not be a full 
"partner." 

How overcome? Very careful to appoint 
"non-Government" people to almost all 
leadership positions and County personnel 
have more "Staff support roles." Most 
decisions/work product come from the 
community and county staff could "edit" but 
not change the content. This concern was 
continually discussed and addressed in an 
open manner. 



Barrier 2: This "health" initiative encompasses 
many social service, law enforcement, 
economic issues and yet the majority of 
participants are from the health sector. 

How overcome? a) We are broadening the 
participation, b) We are facilitating the 
"ownership" of this initiative by a couple of 
key collaboratives (one in County government 
and one external) that span all the sectors. 
(One of our five sponsors. Children's Initiative, 
is the external collaborative.) 



5. How is it funded? City/County/Local government funds; MCH block grant funds. 
What is the approximate annual budget for this initiative? $100,000/year. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? 
Yes. Data is collected from Vital Records and several other sources. This will be revised 
semi-annually. Implementation of specific "Priority Actions" by those committed to them 
will be followed/coordinated by Action Coordinators as well and the status of 
implementation will be communicated to the community at large. Final draft of the Plan 
has been written (printed by November). Initial implementation on Actions has begun. Our 
"official" unveiling of the initiative is being arranged for the Fall. 

6b. Has this initiative been formally evaluated? No. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? This essentially carries out the assessment, planning, and policy development Public 
Health roles that have been agreed upon. (The assurance role is presently a smaller "piece" 
thus far.) This is done through a Strategic Plan model meeting a "Community organization" 
model. 



7b. Has this program been replicated elsewhere? No. 
if yes, where? 



183 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Santa Clara (CO) Valley Health and Hospital System Public Health 

Department/MCAH Division 
CITY/STATE: San Jose, CA 



CityMatCH CONTACT: 
TELEPHONE: 



Julie Grisham, MCAH Director 
408/299-5036 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: MCAH Community-Wide Strategic Planning Process 

1b. CategorY(ies) that best apply to your initiative: 

Strengthening Urban Public Health Systems - 37 Strategic planning for urban MCH 



Describe the initiative. In February 1994, the MCAH division of the Public Health Department 
was selected to be one of three pilot counties in California to receive the Family Health 
Outcomes Project technical assistance package. The project is providing technical assistance in 
MCAH quantitative needs assessment and the development of health status/outcomes indicators 
for public health monitoring and program design and evaluation. In May 1994, a private 
consultant firm specializing in Strategic Planning was contracted to work with the MCAH 
Director to design a plan for implementing a community-wide strategic planning process for 
MCAH in Santa Clara County. These two efforts were combined, and through a collaborative 
process with MCAH providers within the Santa Clara Valley Health and Hospital System 
(includes Public Health, Mental Health, Alcohol/Drug Abuse, Ambulatory Care/Primary Care, and 
the Hospital), a planning process was developed. The scope of the plan will be two tiered. The 
first tier will address the range of issues traditionally included under MCAH such as infant 
morbidity/mortality, teen pregnancy, immunization etc. The second tier of the plan's scope will 
focus on those issues which affect MCAH but are outside the capacity of public and private 
MCAH providers in coordination with MCAH. Some examples of these are homelessness, 
poverty, and racism. 



3a. in planning and implementing this activity, what has been the leadership role of your health 
department? The MCAH Director submitted the proposal to obtain the technical assistance 
package from the Family Health Outcomes Project. In collaboration with top officials and the 
Data Manager, she also contracted with the Strategic firm and has been active in facilitating the 
process. There are still many details and political implications to work out, and the MCAH 
Director and key MCAH managers and staff will provide leadership to the community to promote 
a truly collaborative MCAH Strategic Plan. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? The leadership of the Public Health Department has been enhanced by; the formation of 
the MCAH coordinating Council with all MCAH providers within the Valley Health and Hospital 
System; the ongoing collaboration, leadership, and/or staffing of most of the major MCAH 
Community groups and networks in Santa Clara County ; and by the commitment of the top 
leadership within the Board of Supervisors, within the Health System and in the community to 
address MCAH issues. 



184 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Lack of coordination and/or focus of 
the community in addressing MCAH issues as a 
whole. There are many MCAH community 
groups, networks, collaborative, advisory 
committees, task forces etc. with no 
acknowledged coordinating body looking at or 
being able to speak for MACH issues community 
wide. The result is a great deal of well meaning 
efforts that are fragmented and sometimes 
duplicative. 

How overcome? We are currently in the process 
of addressing this barrier. There have been 
internal meetings to address combining some of 
the perinatal groups. The next step is the 
consultant, the PH Director and the MCAH 
Director meeting with leadership from current 
large MCAH coordinating groups to dialogue and 
determine whether to enhance or combine for 
implementation the MCAH strategic planning 
process. 



Barrier 2: The perception by MCAH leaders, 
public and private, that there has already been a 
great deal of MCAH planning in Santa Clara 
County and that people are tired of planning and 
want action. 

How overcome? When either the consultant or 
MCAH director meet with top officials, MCAH 
public and private providers, and community 
groups, we begin by acknowledging that Santa 
Clara County is a sophisticated and knowledgeable 
County in terms of defining MCAH issues. We 
also acknowledge the commitment and excellence 
of the services that are currently being provided to 
MCAH vulnerable populations. We then promote 
"buy in" by sharing data and health outcome 
indicators to support the prioritization of issues 
and assure that a "strategic plan" involves action 
plans and follow up to obtain funding and 
implement programs that address the issues. 
Overcoming this barrier will be an ongoing 
process. 



How is it funded? City/County/Local government funds, Other: State Dept of Health. Services 
What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What are the major accomplishments to date? The planning process has 
specific objectives which involve: 1 ) Defining the scope of the plan; 2) Planning for and 
implementing community involvement/input; 3) Defining and implementing the structure of the 
process; 4) Utilizing Data for determining priorities and ongoing evaluation; 5) Utilizing the MCAH 
year 2000 objectives. 

Have defined the planning process. Have "buy in" from many public and private agencies in the 
Health System and Community. Have defined many of the MCAH data indicators/health outcomes 
that are most crucial to address in Santa Clara County. 

6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? because planning for the coordination and development of MCAH services in many urban 
communities has similarities in terms of complexity, data and assessment needs, structure/process 
needs, "buy in" and internal and political support, evaluation, funding, setting of priority issues and 
exploring implementation of programs to address the issues, to name a few. 

7b. Has this program been replicated elsewhere? San Diego County developed a MCAH Plan that 
encompasses similar areas to our plan. The vision for the Santa Clara County Strategic Plan, will 
rely more heavily on data health indicators/health outcomes and action plans/funding projects to 
meet priorities. There may be other MCAH strategic plans in other health jurisdictions in the 
United States of which we are not aware. 



185 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's nnost successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



San Juan Health Department 
San Juan, Puerto Rico 



CityMatCH CONTACT: 
TELEPHONE: 



Dr. Magda Torres 
809/751-6975 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: No Barriers To Immunization - San Juan 2000 

1b. Category(ies) that best apply to your initiative: 
Child Health - 10 Immunization 



Describe the initiative. One of the efforts of the Municipality of San Juan is to achieve the 
goal that by year 2000, 90% of children are adequately immunized by age 2. To this 
effect and following federal guidelines we developed a series of meeting and coordination 
with different representatives of public and private sectors, agencies and institutions of our 
community, to form a partnership and submit a proposal. 

In 1992 the San Juan Health Department, submitted an lAP proposal requesting funds to 
help improve immunization programs and implement new initiative that could help achieve 
our goal. As a result an action plan (Infant Immunization Initiative - San Juan 2000) was 
elaborated based on the problem and needs assessment of our community. 

Immunization services hours were expanded in each of our nine Diagnostic and Treatment 
Centers from 7:00 a.m. to 3:00 p.m. Extended hour immunization services were open on 
1993. It operates from 5:00 p.m. to 8:00 p.m. (weekdays) at one DTC per week and from 
8:00 a.m. to 12:00 noon on Saturdays at 2 DTC's (addendum 1). Also in February 1993, 
five (5) Satellite Immunization Clinic's were open at CBO's high risk areas for vaccine 
delinquency on San Juan. 

A mobile unit team devotes 50% of their time to these CBO's Satellite Clinics and special 
immunization activities at different areas of San Juan. Plan emphasizes mainly on the 
removal of barriers, increased services, education and orientation. 



3a. in planning and implementing this activity, what has been the leadership role of your health 
department? Our Health Department has acted as coordinator and leader in the joint effort 
between the public and private sector. Meetings were done at our facilities, and barriers 
and problems related to immunization services were identified and corrective solutions were 
suggested. Also CBO's interested in offering their facilities to establish Satellite Clinics 
signed as agreement. Our new plan initiated by January 1993 and federal funds were 
given by March 1993 ($82,181) which help part of the activities needing funds. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes, this initiative has permitted different public and private sectors to get a 
better view of the work done at San Juan City Health Department, Maternal and Child 
Division. It has also enhanced their input and cooperation to the immunization activities for 
the different sectors of San Juan. 



186 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Financial funds needed and 
requested for new personnel to meet the goal 
weren't granted. 

How overcome? These objectives were reset 
and the limited resources were adequately 
distributed to improve the existing services 
and open extended hours Immunization 
Services. 

Utilization of S.J.H.D. existing personnel was 
done for these efforts. Incentive bonuses for 
the increasing functions were given which 
otherwise required an increase in salaries. 
This is more cost effective. 



Barrier 2: Patient's safety: patients are 
reluctant to attend the extended hour services 
for vaccination due to the high criminality rate 
at night hours. 

How overcome? For the moment the security 
of each DTC is being improved (more 
watchman, bullet proof doors). Problems are 
not yet totally overcome. 



5. How is it funded? City/County/Local government funds, Other Federal funds. 

What is the approximate annual budget for this initiative? An approximate of $3 million. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What are the major accomplishments to date? Yes. We 
had determined that DPT-4 (the four doses of DPT) administered to children below two 
years be our measurable outcome objective. Data Is gathered by the statistic office and 
evaluated periodically by our office. For the first year of our project we achieved and 
surpassed our outcome objective. Our outcome objective 1994 was 2,886 doses of DPT-4 
(addendum 2). By the end of December 1993, we had administered 3,223 doses of DPT-4 
to children below 2 years of age (addendum 3). Also, an adequate system was coordinated 
with private hospital and physicians office for referral to our services for those who cannot 
afford vaccines. 



6b. Has this initiative been formally evaluated? 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Because it offers options to clients who can't go to our regular immunization clinic 
either because of distance or working schedule. Up to December 1993 (Project 1st year) 
3,731 doses of all vaccines were administered at extended hour services and 1,364 at 
CBO's clinics. (Addendum 4 and 5) 



7b. Has this program been replicated elsewhere? No 



187 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's nnost successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Orange County Health Care Agency 
Santa Ana, CA 



CityMatCH CONTACT: 
TELEPHONE: 



Len Foster 
714/834-3882 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Perinatal Substance Abuse Services Initiative 

1b. Category(ies) that best applies to your initiative: 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. Faced with the growing realization that perinatal substance abuse represents a 
significant health problem within the Orange County community; that women of childbearing age who 
abuse alcohol and other drugs have either limited access to medical care or are not motivated to seek 
medical care; that pregnant substance abusing women represent the single greatest risk for adverse 
birth outcome, the county health officer initiated an interagency task force to examine the problem 
and formulate solutions. 

The result was the Perinatal Substance Abuse Services Initiative, which is designed to provide 
intake, assessment, case management and coordination, and monitoring/evaluation services in 
support of substance abusing women, particularly those who are pregnant. Services are provided by 
public health nurses. The Initiative was created by a Task Force representing the County's alcohol, 
drug abuse, MCH, HIV/STD, public health nursing, and social services agency management. It also 
included a private not for profit, perinatal case management organization. 

The Initiative provides case management of clients in a unique manner, inasmuch as they "fill in the 
gaps" of client support and case coordination when clients are known to more than one service 
organization. Specifically, the Initiative staff address the issue of medical care for clients enrolled in 
substance abuse treatment programs, and provide the liaison between the medical care provider and 
the substance abuse treatment provider. Initiative staff work with community outreach staff 
associated with the social services agency to link identified substance abusing women with drug 
treatment programs, medical care providers and other resources. In essence. Initiative staff view the 
client in totality, rather than limiting their activities to a specific portion of the client's needs. 
Additionally, Initiative staff assist in the training of medical providers to understand the unique needs 
of those high risk clients so that they are better able to retain them under care. By so doing, both 
community capacity is increased and birth outcomes improved. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The county health officer was the official who initiated the process leading to the 
development of the Perinatal Substance Abuse Services Initiative. He appointed, or caused to be 
appointed, the members of the Task Force, and was vested with the ongoing responsibility for 
operation of the Initiative. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, why? 

The health department's leadership position has been enhanced both within the county family and the 
community. Through this process, other county agencies, particularly drug and alcohol treatment 
programs and the social services agency, developed an improved understanding of the value of public 
health staff in collaborative settings. Private obstetrical providers have learned of the value of public 
health staff in supporting their efforts by extending case coordination to their clients. This 
acknowledgment may be of greater importance within the context of a managed care environment. 



188 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Organizational jealousies and issues of 
turf that lead to concerns about control of the 
Initiative and resources. 

How overcome? All county organizations involved 
in the provision of related services to substance 
abusing women were given equal representation on 
a policy steering committee which provided 
oversight during the design process. Additional 
representation from all operating units was 
provided on a technical coordination committee, 
which was responsible for the development of 
system design, process flow, and the resources 
requirements. All decisions were based on 
consensus, and while there was a position of chair 
(a public health representative), the chair 
functioned more in the role of facilitator. This 
process built trust and facilitated share ownership 
of the Initiative. 



Barrier 2: Funding of a new project at a time when 
budget restrictions impacted all county agencies 
and departments. 

How overcome? Building upon the shared 
ownership of the Initiative, a formula was 
developed to allow the cost of the Initiative to be 
shared among the major players. While a 
substantial portion of the cost was absorbed by 
public health with the support of Tobacco Tax 
revenues, the drug and alcohol programs share the 
cost of one support position, and the social services 
agency absorbed the cost of space, equipment and 
overhead. 



5. How is it funded? Tobacco Tax revenues. Drug and Alcohol Program funds. Social Service Agency 
funds. 



What is the approximate annual budget for this initiative? $242,776 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Outcome objectives 
have been developed. They relate primarily to the success in gaining access for pregnant, substance 
abusing women into substance abuse treatment and prenatal care; their continuation under care 
through six months post partum; and the results of toxicology testing at delivery. Data is collected 
manually by Initiative staff via access to client records granted through a signed, multi-agency patient 
consent form. Preliminary data is quite promising. However, the numbers are too small, and the 
process is too new to be meaningful at this time. 

6b. Has this initiative been formally evaluated? Yes. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? The principles of coordination of care are consistent regardless of the community. The 
Initiative described merely represents a system of augmenting existing program staffing and case 
coordination efforts with an overlay which is designed to fill in the gaps which would otherwise 
result. Such a model could readily be modified to correspond to the needs of another community. 



7b. Has this program been replicated elsewhere? No. 
If yes, where? 



189 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



County of Sonoma Department of Health Services 
Santa Rosa, CA 



CityMatCH CONTACT: 
TELEPHONE: 



George R. Flores, MD, MPH 
707/576-4700 



CONTACT FOR MORE INFORMATION: Norma Ellis, Director of Nursing (707/576-4731) 



la. Initiative Name: Sonoma County Maternal Child Health (MCH) Strategic Planning 

lb. Category(ies) that best applies to your initiative: 

Strengthening Urban Public Health Systems - 37 Strategic planning for urban MCH 



Describe the initiative. In February 1994 the Sonoma County MCAH team attended a state 
conference on public health leadership and community-based planning strategies around MCAH 
populations. Upon returning to the county, the core team used this information to co-sponsor, with 
the local MCAH Council, a community-based, two half-day planning event regarding the major 
problems and solutions for MCAH target populations. Over 80 participants were invited (public and 
private agencies and clients) with a goal of about 50 attendees. Participants were provided with a 30 
page document, prior to the meeting, which included local and state MCAH health indicators. A key 
note speaker began the meetings by urging participants to include political, social and economic 
issues, which impact the health of the population when they were considering problems, issues and 
solutions. Participants were assigned to one of four groups based on their agency's background, 
which were either maternal, infant/toddler, school-age or adolescent health. Each group had a 
facilitator and documenter, who used a very directive and structured process called IHES. Each group 
was to define the key health problems, causes of the problems and solutions for their target groups. 
Following the meetings, the results were analyzed and provided back to the participants in a formal 
report as follows: 

Maternal Population : primary health problem is the breakdown of the primary support system of 
family and community chased by poor economics and ineffective programs. Solutions included 
improved collaboration between existing programs. Infant/Toddler: Primary health problem was lack 
of community involvement and participation of parents caused by a lack of sense of community or 
connectiveness in neighborhoods. Solutions were to establish a sense of community by holding small 
community meetings focusing on known problems to achieve community empowerment. School Age : 
Primary health problem was poor access to care caused by inadequate funding of services and low 
fee reimbursement for providers. Solutions were to shift existing funding to meet prioritized needs. 
Adolescent : Primary health problem was a lack of role models for teens, lack of parental guidance 
and overall lack of attention to their needs caused by no clear definition or expectations around good 
parenting or awareness of obligations. Solutions were creating and promoting definitions of good 
parenting and parenting education at all levels and opportunities throughout school. 

Also included were suggestions for future actions for agencies and the health department and a 
survey to evaluate the planning event and the report. As a thank you, all participants were also 
provided a health department report called Health Profile'94: The Health of Our Community with a 
variety of health indicators on the overall community. 



190 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The health department role was to identify that this event was innportant to the 
community, to plan, invite and hold the planning sessions and to report back to the participants about 
the findings and potential future plans. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, why? 

Many participants remarked that this planning was important and that they were pleased that the 
health department took the initiative to set it up. Follow-up activities by the health department will be 
imperative to continue the momentum and the positive image that was set by this initiative. 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Choosing a tool for the planning 
sessions. 

How overcome? Choosing a tool, which would be 
easy to understand and implement, for taking the 
groups through the initial planning phase was 
somewhat of a barrier. The core team reviewed 
several tools taught in the Leadership Workshop 
such as the nominal process, Delphi, etc. Other 
tools already known to the group were also 
reviewed. The IHES (Insuring Health Environments 
in Schools) was chosen because it was very 
structured and directive and built on three 
concepts (brainstorming, advocacy and prioritizing) 
which built group consensus. Upon evaluation 
100% of participants felt that the process always 
or usually resulted on group consensus. 



Barrier 2: Communication between participants 
whose focus and agendas were somewhat diverse. 

How overcome? While the diversity made 
communication between participants difficult, it 
also served to expand the understanding of the key 
problems that were identified and helped address 
what role economics, politics, etc. played in 
impacting the health issues identified for target 
populations. These differences were simply 
acknowledged and incorporated into the report. 



5. How is it funded? MCH block grant funds; March of Dimes and Health Plan of the Redwoods each 
contributed funds to cover lunches and continental breakfast for 55 participants. 

What is the approximate annual budget for this initiative? $8,1 30 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? The primary objective 
was to hold an event co-sponsored between the Health Department and the local MCAH Council in 
order to provide community-based planning for the health of the MCAH population. 

6b. Has this initiative been formally evaluated? Based on the evaluations turned in by participants, 94% 
felt that the MCAH issues, causes of issues and potential solutions were very pertinent or somewhat 
pertinent to the MCAH target population. 



7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? This would be (and has been) successful in another urban community because it sets up a 
workable forum for groups to meet, exchange ideas and plan, using group consensus, regarding the 
important issues within their community. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? In other California counties. 



191 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 

HEALTH DEPARTMENT: Seattle-King County Health Department 

CITY/STATE: Seattle, WA 



CityMatCH CONTACT: 
TELEPHONE: 



Kathy Carson 
206/296-4677 



CONTACT FOR MORE INFORMATION: Cathy Gaylord 



la. Initiative Name: Expanded School Intervention Team Project 

1b. Category(ies) that best applies to your initiative: 

Child Health - 17 School-linked/school-based services 



Describe the initiative. The "Expanded SIT" Project adds community-based agency 
representatives to existing school interventions teams (SITS) and gives the teams access to 
flexible funds to purchase for children and families health and social service items and 
services that are unavailable through existing programs. The Expanded SIT model was 
selected for implementation under the Robert Wood Johnson Foundation Seattle Child 
Health Initiative (based at Seattle-King County Health Department) because it offered a 
mechanism for improved service integration and smoother service coordination and was 
suitable for testing the concept of a flexible fund. Three schools established Expanded SITs 
under the Child Health Initiative during the 1993-1994 school year. After the state-funded 
Readiness to Learn Project (administered by the Seattle Department of Housing and Human 
Services) also opted for the Expanded SIT model, an additional 3 schools joined the 
Expanded SIT Project. This project operates as a collaboration between Child Health 
Initiative and Readiness to Learn. 

The participating schools selected community-based agency representatives from 
public-health, mental health, child welfare, social services, and family support agencies. 
Community-based representatives attend the school SIT meetings on a regular basis, 
participating in the staffings and assisting in deliberations over where resources might be 
found to meet needs and whether it is necessary to tap the flexible fund. The parent is 
included as a member of the team staffing their child, building on family strengths and 
responding to needs with individualized services. 



3a. in planning and implementing this activity, what has been the leadership role of your health 
department? As the RWJ grantee, the Health Department brought together the community 
advisory board that conceived the project. The grant funded coordinator negotiated with 
RWJ to accept the advisory board's plan, identified community agencies willing to commit 
staff time, and devised the mechanisms for operation of the flexible fund. She also 
collaborated with the writers of the Readiness to Learn grant to adopt the same model so 
that additional sites could be funded. 



3b. Has the leadership of the health department been enhanced as a result of this activity? 
so, why? The project has added to the Health Department's experience in collaborative 
projects and has increased our credibility with school personnel. 



If 



192 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Medicaid Managed Care 

How overcome? Expanded SITs can assist 
families to access care in a managed care 
system, but school-based service delivery, 
especially EPSDT which can be a gateway to 
other services. Is no longer feasible. The 
seven managed care plans serving the county 
will not authorize school-based services. 



Barrier 2: Community agency staffing 
limitations. 

How overcome? Still somewhat of a problem, 
but experience has shown them the value of 
being involved. Expansion to other schools 
will be difficult If additional resources cannot 
be found. 



5. 


How 


is it funded? General state funds; 


Private sources - RWJ Foundation; 


and Other - 




Medicaid Administrative Match. 








What 


is the approximate annual budget for this initiative? 





6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? A 
formal evaluation Is being developed In conjunction with Readiness to Learn. Data is being 
collected on the number of students staffed, their needs, and how their needs were met. 
The major accomplishments to date have Included the extension of the project using a state 
Readiness to Learn grant and the enthusiastic support for the project that is expressed by 
staff from each of the schools Involved. 

6b. Has this initiative been formally evaluated? No, (by 6/95) 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? Because the model Is designed to use existing community resources to target the 
individual needs of children and families, it Is likely to be successful anywhere. 

7b. Has this program been replicated elsewhere? Not Known 

If yes, where? 



193 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Spokane County Health District 
Spokane, WA 

Barbara Feyh 
509/324-1617 



CONTACT FOR MORE INFORMATION: Lisa Ross 



la. Initiative Name: Parents and Professionals Activating Coordinated Care and Transitions. 

1b. Category(les) that best applies to your initiative: 

Women's Health - 01 Preconception health promotion 
Prenatal Health - 06 Home visiting 



2. Describe the initiative. Children with Special Health Care Needs Special Project . One stop 
shopping is available through the on-site provision of special education, physical, 
occupational and communication therapies, pediatric evaluations, nutritional consultations, 
orthopedic evaluations, case management services, parent to parent linkages, counseling 
services and parent support groups. 

The project will add case management, public health nurse home visiting and psychosocial 
services to the therapy and medical services currently provided young children with special 
health care needs in Spokane, WA. Public health nurse home visiting, social work 
counseling and parent to parent support groups add to the one-stop shopping within a 
community-based early intervention center. The project merges the private, non-profit and 
public agency personnel to improve access to appropriate services, decreases 
fragmentation of services, and modeling, the fragile and critical point where families begin 
services for their special needs infant, the project strives to empower families to eventually 
become their own case manager. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Health District originated the idea for the project and worked with our 
local neuromuscular center to write the grant. The neuromuscular center is the grantee 
who then subcontracts with the Health District. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? Yes. Spokane County health District has been providing service to special needs 
children and their families for years. The addition of this project has increased community 
awareness of the Health District's role with this special population. 



194 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : The project experienced a 45-day 
delay in hiring the public health nurses. 
Drafting the legal inter-agency contract and 
filling the positions in accordance with state 
and federal hiring mandates contributed to 
this delay. 

How overcome? The project has been able 
to hire all necessary staff and complete 
training requirements. 



Barrier 2: 

How overcome? 



5. How is it funded? Other Federal funds - CISS; Non-Federal match. 
What is the approximate annual budget for this initiative? $177,900 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Yes. The project has 
yet to complete its first year. 

The project will be evaluated on the basis of its measurable objectives, summary time table, 
parental satisfaction surveys and budget compliance. This information will be reviewed bi-monthly by 
a committee comprised of the project director, public health nurse supervisor, developmental center 
executive director and the chairperson of the Program Enhancement Committee from the 
developmental center's Board of Directors. 

In accordance with the Washington State MCH needs assessment goal to develop a system for 
statewide data collection and analysis, both the local Spokane County Office of Children with Special 
Health Care Needs and Spokane Guilds' School have accepted initial contract monies for computer 
systems and software. 

6b. Has this initiative been formally evaluated? No. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes. 

Why? The project intermingles the personnel and knowledge resource base of the private non-profit 
sector and the public health district. This networking exponentially enhances information and service 
delivery to families of young children with special health care needs. 

Every community has the capacity to "marry" the private non-private sector with public health. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



195 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



St Paul Public Health Department 
St Paul, MN 

Diane Holmgren 
612/292-7712 



CONTACT FOR MORE INFORMATION: Anne Kuettel 



la. Initiative Name: Children's Immunization Project 

1b. Category(ies) that best applies to your initiative: 
Child Health - 10 Immunization 
Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. The Children's Immunization Project is a public/private partnership 
of many agencies which provide immunizations and related services to area residents, 
primarily focusing on the Saint Paul community. 

The project has been developed over the past two years into a collaborative effort to 
increase the immunization levels of Saint Paul Children. 

Recently 50 volunteers from the various agencies. Saint Paul Public health, 
Children's Hospital of Saint Paul, a community clinic, pediatric clinics, the Minnesota 
Department of Health, WIC, and local Kiwanis group, provided outreach and 
information to approximately 3,000 shoppers at a TARGET store in one of Saint 
Paul's neighborhoods targeted for immunization improvements. This was a 
successful Sunday afternoon, and the results of contacts going to providers for 
immunization after the outreach and education was already realized within the first 
week after the event. 

The Children's Immunization Project plans additional activities to increase the level 
of awareness to increase immunization rates among children. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? Anne Kuettel, PHN from Saint Paul Public Health serves as Co-Chair of the 
Children's Immunization Project. This role has been vital to the growth and stability of the 
Project. The other Co-Chair is a representative from Children's Hospital of Saint Paul. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so. why? The leadership has been enhanced on a personal and organizational level through 
this challenge, and recognition that Saint Paul Public Health is willing and able to take a 
leadership role and work collaboratively with many other agencies, to help achieve the 
overall goals. 



196 



4. What have been the greatest barriers faced in implementing this initiative? 


Barrier 1 : Seoaratina individual aaencv 
interests from the goals of the 
collaborative. 

How overcome? As with anv 
collaborative effort with multiple 
agencies, this is a challenge. 


Barrier 2: 

How overcome? 



5. How is it funded? Private Sources, local agencies. Community Health Services Funding. 
What is the approximate annual budget for this initiative? 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? The 
overriding goals of the Project is to improve the immunization status of children, both as a 
collaborative, and within the individual organizations. The focus is on removing barriers and 
improving access, eliminating "missed opportunities", and providing education to clients 
and also to the provider community. 

6b. Has this initiative been formally evaluated? No 



7a. Do you think that this initiative would work if implemented in another urban community? 

Why? This initiative could work anywhere that there is a commitment to partnerships as an 
effective means to address local public health issues. 

7b. Has this program been replicated elsewhere? 

If yes, where? 



197 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



HRS Pinellas County Public Health Unit 
St. Petersburg, FL 



CityMatCH CONTACT: 
TELEPHONE: 



Claude M. Dharamraj, MD 
813/824-6900 



CONTACT FOR MORE INFORMATION: Susan Gilbert, Project Manager 



la. Initiative Name: Healthy Families Pinellas (HFP) 

1b. Categoryiies) that best applies to your initiative: 
Prenatal Health - 06 Home visiting 



Describe the initiative. Healthy Families Pinellas (HFP) is a family driven, community-based home 
visiting program administered by the HRS Pinellas County Public Health Unit (PinCPHU). The 
voluntary program works with the newborns of families targeted by census tracts through 
referrals from local hospitals. The key component strategy is the development of a family 
support plan(s) that seeks to empower the family as the ultimate broker of services. The 
intensity of service is based on the individual family level of need and is available for up to five 
years. Families are moved through various levels (i.e., Level I - Level IV) of service intensity 
according to established criteria. Paraprofessionals are used as home visitors, whose role is to 
help families reach their goals through completion and periodic assessment of a Family Support 
Plan (FSP). The paraprofessionals also work one-on-one with the family, teaching parenting 
skills, checking development of the infant, encouraging immunizations and well-baby visits and 
providing linkages to other community resources and services. Project services are available 
year round with 24-hr/day coverage utilizing an on-call system for evening, weekend, and 
holidays. The program is collaborative and the teams are made up of staff from PinCPHU, 
Family Service Centers, Inc., and the YWCA of Tampa Bay, Bayfront Medical Center and Morton 
Plant Hospital. There is an advisory committee to the project. Currently, there are three teams 
serving 17 census tracts in Pinellas County, with plans to expand each year for the next three 
years. The staff/families caseload ratio is 1/25. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The HRS PinCPHU applied for and was awarded the grant for this collaborative in 
October 1992. The PinCPHU is the lead agency in the collaborative initiative and has 
responsibility for the entire budget. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, 
why? Healthy Families Pinellas has become a local model for case management initiatives. The 
program has helped to bring the Health Unit into the forefront as a serious player, in the child 
welfare, social service arena. Because of this, the link of medical services to social services has 
become much stronger in our community. 



198 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Lack of community resources lil<e day 
care, housing, etc. 

How overcome? Through informal, yet 
creative, collaborations, we have worked with 
the local housing authority and subsidized day 
care agency. This resulted in our clients being 
targeted for a special housing program and 
opened up 25 day care slots, we otherwise 
would not have had. 



Barrier 2: Increasing number of illegal Hispanics, 
who are not eligible for community services such 
as day care. 

How overcome? Not overcome; contact with 
the other programs experienced in dealing with 
such population. Also restructured program to 
meet needs of clients by translating existing 
materials into Spanish, hiring Spanish-speaking 
staff, and developing new materials. 



5. How is it funded? Private source: Independent Taxing District for Children's Services. 
What is the approximate annual budget for this initiative? 1994-95: $900,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used 
in monitoring the initiative? What have been its major accomplishments to date? The overall 
objective of the Healthy Families Pinellas Project is to prevent child abuse and neglect in the 
targeted families. Yes, the PinCPHU HFP Initiative have specific, measurable objectives. We 
have a data base and information is collected by forms and entered daily. We complete a 
semi-annual report to our funder (Juvenile Welfare Board of Pinellas County) and evaluator 
(University of South Florida). 

There are different measurable objectives for successive years. 1) 75% of families referred 
by Bayfront Medical Center as high risk will accept home visiting services from HFP Family 
Support Worker (FSW). 2) 90% of families accepting home visiting services who remain active 
will have a documented individual FSP developed within the first 3 months. 3) 90% of active 
families with FSP will have been referred to community-based resources. 4) 85% of the families 
receiving home visiting services will not be involved in a confirmed report of child abuse and 
neglect. 5) 90% of families active in the program for 6 months or longer will be attentive to the 
medical needs of the infant. 6) 80% of families active in the program for 6 months or longer 
will show an improvement in bonding relationships. 7) 90% of all the enrolled infants will be 
assessed within the first 6th months of enrollment using the Denver II Development Assessment 
Tool. MINIMUM SERVICE LEVEL (1 Team) - 100 Families, 100 Children, 100 Adults 

As of March 31, 1994 only 3% of families had any confirmed reports of abuse or neglect 
since enrollment, 100% target infants were up-to-date on well-baby visits and immunizations 
and 93% of mothers showed appropriate or improved bonding with their babies. 

6b. Has this initiative been formally evaluated? Yes. 

7a. Do you think that this initiative would work if implemented in another urban community? Yes, 
through Healthy Families America, it is being implemented in many urban communities 
throughout the United States. 

Why? It works because it addresses challenges that all urban communities face. 

7b. Has this program been replicated elsewhere? Yes. 

If yes, where? One in Florida: Polk County. 



199 



1994 Urban MCH Leadership Conference Profile 



Describe your health departnnent's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



San Joaquin County Public Health Services 
Stockton, CA 



CityMatCH CONTACT: 
TELEPHONE: 



Susan DeMontigny, MSN, PHN 
209/468-0329 



CONTACT FOR MORE INFORMATION: 



la. Initiative Name: Lead Poisoning Prevention Project Collaboration and Expansion 

lb. Category(ies) that best applies to your initiative: 
Child Health - 1 5 Lead poisoning 



Describe the initiative. With the increasing effort to screen for and identify lead burdened children, 
San Joaquin County Public Health Services identified the need for a more comprehensive and 
collaborative effort between the various divisions involved with these children. The Maternal, Child, 
Adolescent Health (MCAH)/Lead Poisoning Prevention Program Coordinator organized the effort to 
develop a Multi-disciplinary Team (MDT) to meet monthly and develop policies and procedures to case 
manage children who are identified as lead burdened. The team consists of the Health Officer and 
representatives from Environmental Health, Public Health Nursing, Children's Medical Services, the 
Public Health Clinic, Health Education, and the Public Health laboratory. The team also reviews cases 
to determine if further efforts can or need to be made on behalf of these children. Various members 
of the MDT also provide community education, regarding lead poisoning and lead poisoning 
prevention, at community events or to community groups. When the opportunity developed, because 
of extra funding from the State, the Lead Program Coordinator, along with the MDT, was able to 
expand the existing project to include a community outreach pilot project. The pilot project has 
progressed well, already identifying and referring a number of children not previously screened. The 
next phase for the MDT will be to recruit community partners, to promote community awareness, and 
community support for this effort. 



3a. In planning and implementing this activity, what has bean the leadership role of your health 

department? Divisions within the Public Health Department (PHD) have been the primary participants, 
to date. Public Health Nursing has provided case management activities for individual families, and is 
now participating in the outreach project conducting a door-to-door campaign. Environmental Health 
provides source identification, and education regarding abatement, and methods to decrease 
exposure. They are also providing education at community events and to other interested groups. 
Children's Medical Services (CMS) provides education to providers regarding the necessity of 
screening children for lead according to the current CHDP guidelines, as well as Medical Case 
Management. The CMS Newsletter recently featured an article about lead poisoning and the lead 
poisoning prevention. The MCAH/Lead Poisoning Prevention Coordinator, in conjunction with the 
Health Officer, have begun a campaign to educate providers, and the general population, on the 
importance of screening for lead, providing education, and the follow-up activities provided by Public 
Health. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If so, why? 

As a result of the attempt to develop a collaborative effort, with those divisions of Public Health 
working with lead burdened children, the ability to provide services, including screening, assessment, 
education, case management and medical treatment and follow-up has increased significantly. The 
number of children identified as lead burdened has increased, as well as the quality of the follow-up 
care they receive, and services they are offered. Each Division is aware of their specific role in 
managing lead burdened children, and the concern over duplication of efforts is minimized. 



200 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1: Because of minimal funding, obtaining 
the manpower in the various Public Health 
Divisions to provide the additional time and service 
required by this project. 

How overcome? Education to the managers of 
the various Divisions regarding the importance of 
identifying lead burdened children and the 
significant impact lead poisoning may have on their 
lives. Inviting the Division manager to participate 
on the MDT to develop policy and procedures, and 
the discussion of individual cases for case 
management. 



Barrier 2: Mandated reporting, by laboratories, only 
at levels of 25ug/dl and above; cases of lOug/dl to 
24ug/dl were obtained haphazardly. Also, the lack 
of a denominator to determine a rate for San 
Joaquin County. 

How overcome? The Public Health Laboratory and 
the Public Health clinics are currently submitting aH 
lead levels to the Lead Poisoning Prevention 
Coordinator. A letter to other laboratories, that 
process lead levels for San Joaquin County, is being 
developed requesting their cooperation in providing 
the Health Department with a report of all their lead 
tests for children 1 8 years of age and under. 



5. How is it funded? State Lead Poisoning Prevention Branch Allocation. 
What is the approximate annual budget for this initiative? $ 1 30,000 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and used in 
monitoring the initiative? What have been its major accomplishments to date? Specific measurable 
objectives for the lead poisoning prevention program include case management until the individual has 
2 lead levels 15 ug/dl or below or 1 level below 10 ug/dl. Prior to the development of the MDT, data 
was collected sporadically by the individual divisions. A monthly report is now developed that 
indicates the status of the case, and identifies new cases and case closures. Additional data is being 
generated for the pilot outreach project to examine the number of eligible children who have not been 
previously screened, and the number of newly screened children, identified by outreach, who have 
elevated lead levels. 

6b. Has this initiative been formally evaluated? The MDT, and the pilot outreach project, have not been 
operational for a long enough period of time to formally evaluate, although the number of children 
identified as lead burdened has increased due to these efforts. 



7a. Do you think that this initiative would work if implemented in another urban community? 

initiative has the potential to be replicated in other similar size counties. 



This 



Why? The Health Department was able to attain the composition and involvement of representatives 
from the various divisions, in part due to the central location of the health department and the 
representatives involved, and the relatively small population size (500,000) and number of identified 
cases in the County. With increased case identification, the MDT approach may need to be modified. 



7b. Has this program been replicated elsewhere? Unknown. 
If yes, where? 



201 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 



Tacoma-Pierce County Health 
Tacoma, WA 



CityMatCH CONTACT: 
TELEPHONE: 



Amedeo T. Tiam (designee) 
206/591-6537 



CONTACT FOR MORE INFORMATION: JoDee Mosley (206/596-2842) 



la. Initiative Name: Readiness-To-Learn/Family Support Centers 

1b. Category(jes) that best applies to your initiative: 

Child Health - 17 Schooi-linked/school-based services 

Other Outreach - 22 Communicable diseases: STD, HIV/AIDS, Tb, HepB 

Improving Access to Care - 25 Reducing transportation barriers, 26 Expanding private 

sector linkages, 29 Schools and health connections 

Strengthening Urban Public Health Systems - 41 Building coalitions and partnerships 



Describe the initiative. The Readiness-to-Learn/Family Support Center project brings 
together a multidisciplinary team of service providers from public and private agencies and 
community leaders and volunteers to deal with barriers that affect children's performance in 
school. 

It is the goal of the Tacoma-Pierce County Health Department (TPCHD) to assist in 
initiating, stabilizing and filling in service gaps where needed, initially, and to assist the 
different communities and neighborhoods, if appropriate, acquire ownership of the 
program so that it eventually turns into a truly community-based and community- 
directed program. Consistent with this goal is the TPCHD's support for the 
development of Community Advisory Committees whose main role will be to advise the 
program staff in matters pertaining to program and service delivery. 



3a. In planning and Implementing this activity, what has been the leadership role of your health 
department? The Family Support Center/Readiness-To-Learn program is a broad and 
encompassing program which allows the TPCHD to provide preventive programs so that its 
involvement in intervention services-services that must be provided when a health crisis of 
some kind occurs - can start to diminish. Needless to say, behaviors and environments that 
translate into health risk factors have a better chance of being addressed adequately and 
resolved in a prevention mode. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The organizations the TPCHD is partnering with are all community based . This 
fact provides a unique opportunity for the TPCHD to bring its services to the communities 
where services are needed. 



202 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Turf & BureaucracyA/Vho's in 
control. 

How overcome? Continue working together 
with outside and community based agencies; 
right people are together at the discussion 
table; highest access to policy makers. 



Barrier 2: Community Involvement/Not in My 
Backyard! 

How overcome? Work with Community-Based 
Groups; community/neighborhood leaders are 
invited and participate in the planning and 
implementation; Set limits. 



5. How is it funded? City/County/Local government funds; and General state funds. 
What is the approximate annual budget for this initiative? $990,355.00 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? 
This is a new project in which our Office of Community Assessment is currently in the 
process of refining an evaluation measurement. 



6b. Has this initiative been formally evaluated? N/A 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes 

Why? It is expected that assisting children and their families meet basic needs and resolve 
conflicts will contribute to children's readiness for learning and minimize risky behaviors 
that leads to serious health problems. 



7b. Has this program been replicated elsewhere? No 
If yes, where? 



203 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's nnost successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CltyMatCH CONTACT: 
TELEPHONE: 



Pima County Health Department 
Tucson, AZ 

Janice Nusbaum 
602/740-861 1 



CONTACT FOR MORE INFORMATION: Barbara L. Maack (602/298-3888) 



la. Initiative Name: District Office TB Prevention Therapy and Follow-Up 

1b. Category(les) that best applies to your initiative: 

Other Outreach - 22 Communicable diseases: STD, HIV/AIDS, TB, HepB 



Describe the initiative. As a consequence of staff turnover at the core TB program it was 
determined that the job of monitoring compliance with medication prophylaxis would not 
get done. It was felt that by involving PHNs at the District Offices this step would increase 
the availability of staff for service delivery. Also, by making the location of service delivery 
more accessible and convenient for the client, that it might increase compliance with 
medication prophylaxis. The three areas where District Office PHN staff are involved to 
assist the central TB program are: 1) Surveillance of individuals and families on 
prophylactic INN medication . Staff monitors refill dates and will contact client if client does 
not initiate call when medications are due. A PHN interviews the client and completes a 
flow sheet before issuing refills. This information helps to identify any side effects and to 
assess compliance with taking the medication. 32% of the new TB records opened this 
past year were children. 21 % were between the ages of 5 and 19 years and 1 1 % were 
less than 5 years of age. In addition, 45% were women in the child bearing years of 20 to 
49 years. 2) Skin testing in District Offices/Clinics . During the past year 63% of non-high 
risk PPDs were done at the District Offices/Clinics. Of those with known results, 6% were 
positive. Nationally the rate is 4%. Our higher statistic can be explained by our proximity 
to Mexico, where the incidence of TB is higher than that in the U.S.A. 3) Referrals from 
three local hospitals and one clinic for follow-up of pregnant women with positive PPDs . 
Family contacts were skin tested and mothers were placed on prophylaxis after the birth of 
the baby. Almost all of the women were of Hispanic ethnicity. 64 referrals were received 
for follow-up. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? This initiative was planned and implemented entirely by the Public Health 
Nursing Division. This was not a collaborative effort with other entities. It was a change in 
service delivery method rather than the establishment of a new program. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? N/A. 



204 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Core TB program staff turnover. 

How overcome? 1 ) Education of new staff 
and follow-up, supervision and support of 
staff activities by Nurse Managers at the 
District Offices and the TB program. 2) 
Integration of services made possible by an 
organizational structure that allows for a 
decentralized and generalized PHN program. 



Barrier 2: Problems associated with 
decentralization of service delivery. 

How overcome? 1 ) Constant communication 
between the core TB program and the staff at 
the district offices. 2) A matrix form of 
management was designed and implemented 
by the Division of Public Health Nursing, which 
facilitated communication. 



5. How is it funded? City/County/Local government funds; CDC Communicable Disease 
Dollars (through Arizona Department of Health Services). 

What is the approximate annual budget for this initiative? This initiative and TB program 
are integrated into the overall Public Health Nursing Division budget. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? The 
core TB program objective was to increase completion rate of those placed on prophylaxis 
from 79% to 85%. For this past FT 93-94 the District Offices achieved an 90% 
completion rate for those eligible to complete therapy. The change in percent of 
completion rate increased 31 % from that of the 61 % of the centralized office. This data 
was collected using the "TB Data and Monitored Base Program." 

6b. Has this initiative been formally evaluated? No. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? If: a) the local health department has District Public Health Nursing Services; b) and 
if their organizational structure allowed for a generalized Public Health Nursing program 
rather than categorical, with decentralization of services. 

7b. Has this program been replicated elsewhere? No. 

If yes, where? 



205 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



District of Columbia Department of Human Services 
Washington, D.C. 

Patricia A. Tompkins 
202/727-0393 



CONTACT FOR MORE INFORMATION: 



=1 



la. Initiative Name: OMCH Cross Training Efforts 

lb. Category(ies) that best applies to your initiative: 

Improving Access to Care - 33 Increasing social support systems; 35 Increasing access to 

Medicaid 

Strengthening Urban Public Health Systems - 36 Staff training 



Describe the initiative. OMCH coordinated the drafting and subsequent signing in 1991 of 
a cooperative agreement among Title XIX Medicaid Programs, Title V Maternal and Child 
Health Programs, WIC/Commodity Supplemental Food Programs, and the Income 
Maintenance Administration. Cross training between MCH services and Medicaid began in 
1993. The first training session focused on MCH services including primary care, such as 
the neighborhood health centers and the Health Center for Children with Special Needs, as 
well as the Healthy Start Project, the Pregnancy Risk Assessment Monitoring System, 
Pregnancy Nutrition Surveillance System, Pediatric AIDS, and Synergy. The cross training 
that was adopted by the participants (4 sessions) will be completed in September, 1994. 
The training components consists of: MCH Title V and MCH Programs, Medicaid/lncome 
Maintenance Administration Managed Care, WIC/CSFP, and alternative programs/projects. 
Most recently, OMCH approached two units within the Commission on Social Services; 
namely the Office of Paternity and Child Support Enforcement (OPCSE) and Family and 
Child Services Division (FCSD). A formal agreement has been signed with the OPCSE to 
promote public awareness, integrate activities and improve coordination of services and 
resources by both the OMCH and OPCSE. The FCSD collaboration came about in view of 
the increased number of child abuse and neglect cases being seen in the D.C. Court 
system. OMCH felt a need to form a partnership to assist in alleviating some of the 
problems caused by and associated with, child abuse and neglect. It was determined that 
the emphasis should be placed on cross training of all DHS staff who have contact with 
families. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? The Commission of Public Health has assumed the leadership role in this 
activity by contacting other DHS Commissions, Divisions, etc. to participate in this cross 
training activity. Contacts have also been made with private sector community-based 
organizations. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? The leadership has been enhanced in that we are seen as the initiator in this 
strategy and thus viewed as having insight and the ability to respond to problems rather 
than react to problems. 



206 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Maintaining the cooperation of the 
collaborators. 

How overcome? This issue will probably be 
a constant one which we will continue to 
attempt to alleviate. 



Barrier 2: 

How overcome? 



5. How is it funded? City/County/Local government funds; MCH block grant funds; Other 
Federal funds. 

What is the approximate annual budget for this initiative? Basically in-kind services/staff 
manpower. 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used In monitoring the initiative? What have been its major accomplishments to date? 
Yes. We can measure the number of persons attending, participant satisfaction, and 
pre-testing and post-testing on knowledge of the programs. Our major accomplishments 
were in getting three signed, formal agreements with Medicaid, et al. as mentioned 
previously, the Office of Pre-School and Day Care of the United Planning Organization, and 
with the Office of Paternity and Child Support Enforcement. 

6b. Has this Initiative been formally evaluated? No. An evaluation is scheduled for October 1 , 
1994. 



7a. Do you think that this initiative would work if implemented in another urban community? 
Yes. 

Why? It requires someone to take the initiative and make contact with organizations that 
provide similar services and determine how they can assist one another. 

7b. Has this program been replicated elsewhere? Don't know. 

If yes, where? 



207 



1994 Urban MCH Leadership Conference Profile 



Describe your health department's most successful recent initiative in the area of maternal and child 
health. 



HEALTH DEPARTMENT: 
CITY/STATE: 

CityMatCH CONTACT: 
TELEPHONE: 



Division of Public Health 
Wilmington, DE 

Anita Muir 
302/995-8632 



CONTACT FOR MORE INFORMATION: Kris Bennett 



la. Initiative Name: Enhanced Care for Kids - Pilot Project 

1b. Category(les) that best applies to your initiative: 

Women's Health - 02 Family planning, 03 Breast/cervical cancer 
Prenatal Health - 04 Prenatal care; 06 Home visiting 



Describe the initiative. Two years ago, the Nemours Foundation began an initiative to 
establish Children's Clinics to serve low income and Medicaid children across the State of 
Delaware through a managed care waiver. At the outset, it was clear that these pediatric 
practices would be of great benefit to a population without a medical home/access to 
evening and weekend care, but that a great deal of education and follow-up would be 
needed to ensure access and utilization of a traditional medical system. 

Public Health established a collaborative relationship with the Director of the Children's 
Clinics and proposed a model for Enhanced Care for Kids similar to those established for 
pregnant women throughout the states. The role of the Public Health nurse would be to 
link children with their medical home, and to other social services including Medicaid. They 
would visit families at home to enhance the education received in clinics and promote good 
utilization of the medical system. 

Regular collaborative meetings were established, which included Medicaid to develop and 
pilot the model, and to address needs and problems as they arose. 

Currently, there are five (5) clinics in operation in the Wilmington area and each is assigned 
a liaison nurse to work with them to receive and make referrals. They attend regular case 
management meetings and also serve on the community advisory councils for each site. 



3a. In planning and implementing this activity, what has been the leadership role of your health 
department? When the Initiative for Children's Clinics was planned. Public Health was not 
at the table. However, their first site was not ready and Public Health was asked to share 
clinic space temporarily with Nemours. This was the door opener to establish a day-to-day 
working relationship and a chance to teach them what Public Health was about. It was an 
opportunity to establish the collaborative meetings and begin laying the ground work. 

3b. Has the leadership of the health department been enhanced as a result of this activity? If 
so, why? It Is an important lesson to recognize the value of giving up some territory in 
order to gain an Important private-public collaborative relationship. It takes time and effort 
to maintain this relationship. 



208 



4. What have been the greatest barriers faced in implementing this initiative? 



Barrier 1 : Each site operates within a degree 
of independence - each physician sets up a 
practice to their style. Therefore, not all are 
as willing to make referrals and work with 
Public Health nurses. 

How overcome? The collaborative meetings 
held by DPH leadership and Nemours Director 
served as the place to address barriers and 
overcome problems. In one particular 
situation, a change in nurse assigned helped. 
In another, having the public health nurse link 
with a nurse practitioner at the site improved 
the linkage. 

Establishing regularly scheduled meetings at 
each site where referrals were made also 
helped. 



Barrier 2: Many people (clients and 
community) expected this clinic system to 
operate just like Public Health Clinics had 
operated - rather than like private pediatric 
practices. 

How overcome? Several meetings within 
state agencies and within Public Health were 
held to answer questions with regard to the 
Children's Clinic and how to receive services. 
Question and answer sheets were developed 
and distributed to address the "most asked" 
questions. 



5. How is it funded? General state funds. MCH block grant funds. We would like to pursue 
Medicaid reimbursement as a wrap-around service or as an integral part of future managed 
care. 

What is the approximate annual budget for this initiative? $35-40,000 (5 nurses x .2 FTE) 



6a. Does this MCH initiative have specific, measurable objectives? How is data collected and 
used in monitoring the initiative? What have been its major accomplishments to date? We 
have examined the number and types of referrals, the outcomes of cases and the general 
satisfaction of the clinics with the liaison pilot project. A more formal evaluation is 
planned. 

6b. Has this initiative been formally evaluated? No. 

7a. Do you think that this initiative would work if implemented in another urban community? 
Yes, this is classic Public Health at work. 

Why? The key is establishing an understanding by the community of what Public Health is 
uniquely qualified to provide. This requires leadership at many different levels to 
communicate a consistent message. 

7b. Has this program been replicated elsewhere? Yes. 

If yes. where? Virginia (CHIP) 



209 



210 



APPENDIX A: 1994 Conference Planning Committee 



Harry Bullerdiek, MPA 
Project Coordinator, CityMatCH 
Department of Pediatrics, UNiVIC 
600 South 42nd Street 
Omaha, NE 68198-2170 
Phone: 402/559-5642 
FAX: 402/559-5355 



Len Foster, IVIPA 

Co-Chair, 1994 Conf Planning Committee 

Deputy Director of Public Health 

Orange Co Adult & Child Health Services 

P.O.Box 355 

Santa Ana, CA 92701 

Phone: 714/834-3882 

FAX: 714/834-5506 



Donalda Dodson, RN, MPH 

Manager, Public Health for Marion County 

Marion County Health Department 

3180 Center, NE 

Salem, OR 97301 

Phone: 503/588-5357 

FAX: 503/364-6552 



Byron J. Harris 

Deputy Executive Director, USCLHO 

Assistant Executive Director, USCM 

1 620 Eye Street, NW 

Washington, DC 20006 

Phone: 202/293-7330 

FAX: 202/293-2352 



Wayne Duncan, PHA 
Asst Chief, Preg & Infant Health Branch 
Division of Reproductive Health 
Centers for Disease Control & Prevention 
1 600 Clifton Road, Mailstop K-23 
Atlanta, GA 30333 
Phone: 404/488-5187 
FAX: 404/488-5628 



David Heppel, MD 

Director, DMICAH 

Maternal and Child Health Bureau 

Parklawn Building, Room 18A-30 

5600 Fishers Lane 

Rockville, MD 20857 

Phone: 301/443-2250 

FAX: 301/443-1296 



Amy Fine, RN, MPH 

Senior Policy Analyst - Data & Reporting 

Assoc of MCH Programs 

1350 Connecticut Avenue, NW 

Washington, DC 20036 

Phone: 202/775-0436 

FAX: 202/775-0061 



Christine Layton, MPH 

Project Manager 

National Assoc of County Health Officials 

440 First Street, NW, Suite 500 

Washington, DC 20001 

Phone: 202/783-5550 

FAX: 202/783-1583 



Shirley Fleming, DrPH, RN, CNM, MSN 
Deputy Health Commissioner 
Chicago Department of Health 
233 South State Street, 2nd FL 
Chicago, IL 60604 
Phone: 312/747-9815 
FAX: 312/747-9739 



Peter Morris, MD, MPH 

Deputy Health Director for MCH 

Wake County Department of Health 

P.O. Box 14049 

Raleigh, NC 27620 

Phone: 919/250-3813 

FAX: 919/250-3984 



211 



Magda G. Peck, ScD, PA 

Co-Chair, 1994 Conf Planning Committee 

CityMatCH Executive Director 

Department of Pediatrics, UNMC 

600 South 42nd Street 

Omaha, NE 68198-2170 

Phone: 402/559-5138 

FAX: 402/559-5355 



Paula Sheahan 
Director of Outreach 
NCEMCH 

Georgetown University 
2000 N 15th Street, Suite 701 
Arlington, VA 22201 
Phone: 703/524-7802 
FAX: 703/524-9335 



William Randolph, MS 

Associate Director for New Initiatives 

March of Dimes National Birth 

Defects Foundation 
1275 Mamaroneck Avenue 
White Plains, NY 10605 
Phone: 914/997-4461 
FAX: 914/428-8203 



Carolyn Slack, MS, RN 
Administrator, Family Health Services 
Columbus Health Department 
181 South Washington Blvd. 
Columbus, OH 43215-6424 
Phone: 614/645-6424 
FAX: 614/645-7633 



Joan Rostermundt 

CityMatCH Administrative Technician 

Department of Pediatrics, UNMC 

600 South 42nd Street 

Omaha, NE 68198-2170 

Phone: 402/559-8323 

FAX: 402/559-5355 



Patricia Tompkins, RN, MS 
Chief, Office of MCH 
Commission of Public Health 
DC Department of Human Services 
1660 L Street, NW, Suite 907 
Washington, DC 20036 
Phone: 202/673-4551 
FAX: 202/727-9021 



212 



APPENDIX B: 1994 Conference Program 

"Effective Leadership During Times of Transition" 

1994 Urban Maternal and Child Health Leadership Conference 

Saturday, September 17, 1994 

12:00pm - 5:00pm Conference Registration Phillips Ballroom 

Foyer 

2:00pm - 5:30pm Optional Preconference Workshops 
(pre-registration is required) 

• Data 101: Qualitative Problem Solving in Urban MCH National Gallery 

Ballroom A 

Gilberto Chavez, MD, MPH 

Chief, MCH Epidemiology Section 
California Department of Health 
Sacramento, CA 

Ed Ehlinger, MD, MPH 

Director, Division of Personal Health Services 
Minneapolis Department of Health & Family Support 
Minneapolis, MN 

Cara Krulewitch, MD, MPH 

Epidemiologist, Office of Maternal & Child Health 
D.C. Department of Human Services 
Commission of Public Health 
Washington, DC 

Beth Macke, MA, PhD 

EIS Officer 

Division of Reproductive Health 
Pregnancy and Infant Health Branch 
Centers for Disease Control & Prevention 
Atlanta, GA 

Magda G. Peck, ScD, PA 

CityMatCH Executive Director/CEO 
Chief, Section on Child Health Policy 
University of Nebraska Medical Center 
Omaha, NE 

Ken Schoendorf, MD, MPH 

Division of Analysis, Epidemiology & Health Promotion 
Infant & Child Health Studies Branch 
National Center for Health Statistics 
DHHS/Public Health Services/CDC 
Hyattsville, MD 



213 



Saturday, September 17, 1994 

• Program Evaluation: How Do You Know You've Done Renwick Suite 

What You Wanted? 

Peter Morris, MD, MPH 

Deputy Health Director for MCH 
Wake County Department of Health 
Raleigh, NC 

Mary Peoples-Sheps, DrPH 

Associate Professor, Public Health Nursing 
University of North Carolina School of Public Health 
Chapel Hill, NC 

Lou Kelley Brewer 

Assistant Health Director 

Wake County Department of Health 

Raleigh, NC 

6:30pm - 8:30pm CityMatCH Board of Directors Meeting F'eer Suite 



214 



Sunday, September 18, 1994 

8:30am - 11 :30am Optional Preconference Workshops (continued) 
(pre-registration is required) 

• Data 1 02: Advanced Data - Needs Assessment Renwick Suite 

& Freer Suite 

Gilberto Chavez, MD, MPH 

Chief, MCH Epidemiology Section 
California Department of Health 
Sacramento, CA 

Ed Ehlinger, MD, MPH 

Director, Division of Personal Health Services 
Minneapolis Department of Health & Family Support 
Minneapolis, MN 

Cara Krulewitch, MD, MPH 

Epidemiologist, Office of Maternal & Child Health 
D.C. Department of Human Services 
Commission of Public Health 
Washington, DC 

Beth Macke, MA, PhD 

EIS Officer 

Division of Reproductive Health 
Pregnancy and Infant Health Branch 
Centers for Disease Control & Prevention 
Atlanta, GA 

Magda G. Peck, ScD, PA 
CityMatCH Executive Director/CEO 
Chief, Section on Child Health Policy 
University of Nebraska Medical Center 
Omaha, NE 

Ken Schoendorf, MD, MPH 

Division of Analysis, Epidemiology & Health Promotion 
infant & Child Health Studies Branch 
National Center for Health Statistics 
DHHS/Public Health Services/CDC 
Hyattsvilie, MD 

1 1 :00am - 6:30pm Conference Registration Phillips Ballroom 

Foyer 

12:00pm Conference Kickoff Luncheon National Gallery 

Ballroom 



215 



Sunday. Septembar 18, 1994 

12:30pm- 12:45pm Welcoming Remarks: National Gallery 

Ballroom 

Len Foster, MPA 

Co-Chair, 1994 Urban MCH Leadership Conference 
Deputy Director of Public Health 
Orange County Health Care Agency 
Santa Ana, CA 

Mariana N. Kelley, MD 

Acting Comnnissioner 

D.C. Commission of Public Health 

Washington, D.C. 

Audrey Hart Nora, MD 

Director, Maternal and Child Health Bureau 
Assistant Surgeon General 
U.S. Public Health Service 
Rockville, MD 

Giro Sumaya, MD, MPH, TM 

Administrator, Health Resources and Services Administration 
Department of Health and Human Services 
Rockville, MD 

1 :00pm - 1 :45pm Kickoff Keynote Address: Phillips Ballroom 

Giro Sumaya, MD 

Administrator, Health Resources and Services Administration 
Department of Health and Human Services 
Rockville, MD 



Keynote Speaker: 



Joycelyn Elders, MD 

Surgeon General 

U.S. Public Health Service 

U.S. Department of Health and Human Services 

Washington, D.C. 



1:45pm - 2:00pm Break 



216 



Sunday, September 18, 1994 

2:00pm - 4:00pm Panel 1 : Collaborative Models of MCH Leadership in Phillips Ballroom 

Public Health Problem Solving: Healthy Start Projects 

Moderator: Shirley Fleming, DrPH, RN, CNM 

Deputy Health Commissioner 
Chicago Department of Health 
Chicago, IL 

Maribeth Badura 

Deputy Branch Chief, Program Operations 
Division of Healthy Start 
Maternal and Child Health Bureau 
Rockville, MD 

Sheila Webb, RN, MS 

Deputy Director of Health 

City of New Orleans Health Department 

New Orleans, LA 

Karen K. Butler, MPH 

Commissioner of Health 

Cleveland Department of Public Health 

Cleveland, OH 

4:00pm - 4:15pm Break Freer Suite 

4:15pm - 4:45pm CityMatCH Orientation for New Members (optional) Phillips Ballroom 

4:45pm - 6:15pm CityMatCH Annual Business Meeting (open to all) Phillips Ballroom 

6:30pm - 8:00pm Co-Sponsors Networking Reception National Gallery 

Ballroom 

Funded by the National March of Dimes 
Birth Defects Foundation 



217 



Monday, September 19, 1994 

7:00am - 8:00am Continental Breakfast 

8:00am - 9:00am "Urban Children in Need: Responsive and Responsible Leadership' 

Moderator : Magda G. Pecit, ScD, PA 

CityMatCH Executive Director/CEO 
Chief, Section on Child Health Policy 
University of Nebraska Medical Center 
Omaha, Ne 

David Hamburg, MO 

President 

Carnegie Corporation of New Yoric 

New York, NY 

Margaret A. Hamburg, MD 

Commissioner of Health 

New York City Department of Health 

New York, NY 

9:00am - 10:15am Panel 2 : National, Federal, State, and Local Approaches 
to Implementing the Childhood Immunization Initiative 

Moderator : Len Foster, MPA 

Deputy Director of Public Health 
Orange County Health Care Agency 
Santa Ana, CA 

Mrs. Betty Bumpers 

Former First Lady of the State of Arkansas 

Every Child by Two 

The Carter/Bumpers Campaign for Early Immunization 

Washington, DC 

Waiter A. Orenstein, MD 

Director, National Immunization Program 
Centers for Disease Control & Prevention 
Atlanta, GA 

Donald Williamson, MD 

State Health Officer 

Alabama State Department of Health 

Montgomery, AL 

C.M.G. Buttery, MD 

Director, Department of Public Health 

Virginia State Health Department - City of Richmond 

Richmond, VA 

10:15am - 10:30am Breait 

10:30am- 12:00pm Small Groups I : 

The Essentials of Urban MCH Leadership (See Profiles, Question 3) 



Freer Suite 
Phillips Ballroom 



Phillips Ballroom 



Freer Suite 



Group 
Group 
Group 
Group 
Group 
Group 



Ambassador Suite 1 
Ambassador Suite 2 
Hirschorn Suite 
Renwick Suite 
Corcoran Suite 
Smithsonian Suite 



218 



Monday, September 19, 1994 

12:00pm - 1:30pm CityMatCH Regional Planning Luncheon 

1:30pm - 2:00pm Break 

2:00pm - 3:45pm Concurrent Topical Workshops 

1 . School-Based Clinics and Local Health Departments 



National Gallery 
Ballroom 



Hirschorn Suite 



Moderator: 



School Based Clinics 
- National Overview 



School Based Clinics 
and Health Care Reform 



The Portland Experience 



The Denver Experience 



Paul Melinkovich, MD 

Associate Health Director, Community Health Services 
Denver Department of Health & Hospitals 
Denver, CO 

Julia Graham Lear, PhD 

Director, Making the Grade 

The George Washington University 

Washington, DC 

Deborah von Zinkernagel 

Staff Member 

U.S. Senate Committee on Labor & Human Resources 

Washington, DC 

Mary L. Hennrich, RN, MS 

Health Plan Administrator, CareOregon 
Multnomah County Health Department 
Portland, Oregon 

Paul Melinkovich, MD 

Associate Health Director, Community Health Services 
Denver Department of Health & Hospitals 
Denver, CO 



Assessment, Policy Development and Assurance in Action: 
Community Infant/Child Death Review Programs 



Renwick Suite 



Moderator: 



What Will Work: 
Milwaukee's Infant Mortality 
Review Project 



What is Working: 

The New York Experience 



What Has Worked: 

Boston's Case by Case 

Infant Mortality Review Project 



Elizabeth Zelazek, RN, MS 

Public Health Nursing Manager 

City of Milwaukee Health Department 

Milwaukee, Wl 

Elizabeth Zelazek, RN, MS 

Public Health Nursing Manager 

City of Milwaukee Health Department 

Milwaukee, Wl 

Karin Duncan, MSN 

Director, Maternal-Child Health 
Monroe County Department of Health 
Rochester, NY 

Karen Power, MPH 

Director, Office of Research & Health Statistics 
Boston Department of Health & Hospitals 
Boston, MA 



219 



Monday, September 19, 1994 



3. TB Reemerges in Urban Communites: 

Moderator : 

The Case of Orange County 

The Case of Garland 

The Case of New York City 



Implications for MCH 



Corcoran Suite 



Gary Butts, MD 

Deputy Commissioner 

New York City Department of Health 

New York, NY 

Hugh F. Stallworth, MD 

Health Officer & Director of Public Health 
Orange County Health Care Agency 
Santa Ana, CA 

Grace Rutherford, MSN 

Medical Coordinator 

City of Garland Health Department 

Garland, TX 

Gary Butts, MD 

Deputy Commissioner 

New York City Department of Health 

New York, NY 



4. Women's Health 1994: Three Health Issues of Concern to Women 



Smithsonian Suite 



Moderator: 



Women's Health: 

Folic Acid Supplementation 



Women's Health: 
Colposcopy Services 



Women's Health: 
Mammography 



Brenda Coulehan, RN, MA 

Family Health Services Coordinator 

Memphis & Shelby County Health Department 

Memphis, TN 

Lisa Sanford, RN, MPH 

Chief, Preventive Health Services 
City of Laredo Health Department 
Laredo, TX 

Margaret Gier, RNC, MS 

Manager, Women's Health Programs 
Tri-State Health Department 
Aurora, CO 

Jillian Jacobellis, CNM, MS 
Former Director of Policy, Planning 

& Program Development 
Salt Lake City/County Health Department 
Salt Lake City, UT 



3:45pm 
4:00pm 



5:45pm 



4:00pm Refreshment Break 

5:45pm Repeat of Concurrent Topical Workshops 

1 . School-Based Clinics and Local Health Departments 

2. Assessment, Policy Development and Assessment in Action: 
Community infant/Child Death Review Programs 

3. TB Reemerges in Urban Communites: Implications for MCH 

4. Women's Health 1994: Three Health Issues of Concern to Women 

Adjourn for the day 



Hirschorn Suite 
Renwick Suite 

Corcoran Suite 
Smithsonian Suite 



220 



Tuesday, September 20, 1994 
7:30am - 8:30am Continental Breakfast 
8:30am - 10:00am Violence and Public Health: Problems to Policies 

Moderator: Ed Ehlinger, MD, MPH 

Director, Division of Personal Health Services 
Minneapolis Department of Health & Family Support 
Minneapolis, MN 

The Honorable Ellen Anderson 

Minnesota State Senator 

DFL-St. Paul 

Minnesota Legislative Commission on 

Children, Youth & Family 
St. Paul, MN 

Mike Christenson 

Executive Director 
Medica Foundation 
Minneapolis, MN 

Yusef Mgeni 

Executive Director 
Urban Coalition 
St. Paul, MN 



Freer Suite 
Phillips Ballroom 



10:00am 
10:30am 



10:30am Break 

1 2:00pm Small Group II : 

What Works: Local Public Health Departments' 
Response to Violence 



Group 
Group 
Group 
Group 
Group 
Group 



Renwick Suite 
Corcoran Suite 
Smithsonian Suite 
Hirschorn Suite 
National Gallery Ballroom A 
National Gallery Ballroom B 



12:00pm 



4:00pm Open Time: 

Lunch on Your Own 

Capitol Hill Visits (on your own) 



1 :00pm - 4:00pm Set Up Displays for Exhibitors Showcase 



National Gallery 
Ballroom 



12:30pm - 3:45pm Field Visits to D.C. Area MCH Programs (pre-registration required) 
Meet in hotel lobby promptly at 12:25pm. 



221 



Tuesday, September 20, 1994 

4:00pm - 5:30pm Panel 4 : Health Care Reform Update: National and Phillips Ballroom 

State Perspectives 



National Speaker: 



Catherine Hess, MSW 

Executive Director 

Association of Maternal and Child Health Programs 

Washington, DC 



State Speaker: 



Maxine D. Hayes, MD, MPH 
Assistant Secretary 
DOH/Community & Family Health 
Department of Social & Health Services 
Oiympia, WA 

5:30pm - 6:00pm Break 

6:00pm - 8:00pm CityMatCH Networking Reception & Exhibitors Showcase National Gallery 

Ballroom 

6:30pm - 7:30pm Spotlights Presentations National Gallery 

Ballroom 



222 



Wednesday, September 21, 1994 
8:00am - 8:45am CityMatCH Regional Planning Breakfast 

9:00am - 10:45am Panel 5 : Local Public Health Leadership in Times of Transition 

Moderator: Donalda Dodson, RN, MPH 

Public Health Manager 

Marion County Health Department 

Salem, OR 

Gary Oxman, MD, MPH 

Health Officer 

Multnomah County Health Department 

Portland, OR 

Meredith Tipton, RN, MPH 

Director 

City of Portland Public Health Division 

Portland, ME 

Martin Wasserman, MD, JD 

Health Officer 

Prince George's County Health Department 

Cheverly, MD 

1 0:45am - 1 1 :00am Break 

1 1:00am - 12:00pm Summing Up: Next Steps for Urban MCH Leaders and CityMatCH 

Len Foster, MPA 

Co-Chair, 1 994 Urban MCH Leadership Conference 
Deputy Director of Public Health 
Orange County Health Care Agency 
Santa Ana, CA 

Magda G. Peck, ScD, PA 

Co-Chair, 1 994 Urban MCH Leadership Conference 
CityMatCH Executive Director/CEO 
Chief, Section on Child Health Policy 
University of Nebraska Medical Center 
Omaha, NE 

Carolyn Slack, MS, RN 

Immediate Past-Chairperson, CityMatCH Board of Directors 
Administrator, Family Health Services 
Columbus Health Department 
Columbus, OH 



National Gallery 
Ballroom 

Phillips Ballroom 



Phillips Ballroom 



1 2:00pm Final Adjournment 

12:30pm - 2:00pm 1994-95 CityMatCH Executive Committee 
to the Board of Directors Luncheon 



223 



APPENDIX C: 1994 CONFERENCE PARTICIPANTS 
Participating Urban MCH Leaders 



Donna Bacchi-Smith, MD, MPH 
Medical Director, Public Health 
Austin/Travis County Health Department 
Public Health Division 
327 Congress Avenue, Suite 500 
Austin, TX 78701 
(512) 476-0020 
(512) 476-5435 Fax 



Wanda Bierman 

Director of Community Clinical Services 

Kent County Health Department 

700 Fuller NE 

Grand Rapids, Ml 49503 

(616) 336-3002 

(616) 336-3884 Fax 



Polly J. Baker 

Parent, Adolescent, and Child Division Head 

Mecklenburg County Health Department 

249 Billingsley Road 

Charlotte, NC 28221 

(704) 336-9683 

(704) 336-4714 Fax 



Irene Bindrich 

Community Health Nursing Supervisor 

Jefferson County Health Department 

260 South Ripling 

Lakewood, CO 80226 

(303) 239-7003 

(303) 239-7088 Fax 



Joanne Barham, RN 
Community Health Nurse 
Allentown Health Bureau 
245 N. 6th Street 
Allentown, PA 18102 
(610) 437-7615 
(610) 437-8799 Fax 



Anita K. Black 

Manager, Child Health/School Health Services 

Jefferson County Health Dept. 

400 E. Gray Street, P.O. Box 1704 

Louisville, KY 40201-1704 

(502) 574-6660 

(502) 574-5734 Fax 



Gerald M. Barron 

Deputy Director, Bureau of Human Health 

Allegheny County Health Dept. 

3333 Forbes Ave. 

Room 304A 

Pittsburgh, PA 15213 

(412) 578-8032 

(412) 578-8325 Fax 



Constance E. Block 

Nursing Division Director 

Vandenburgh County Health Department 

Room 131 Civic Center 

1 NW MLK Blvd. 

Evansville, IN 47708-1888 

(812) 435-5766 

(812) 435-5612 Fax 



Sidney L. Bates, MA 

Chief, MCH Services 

Kansas City Health Department 

1423 E. Linwood Blvd. 

Kansas City, MO 64109 

(816) 861-2600 

(816) 861-3299 Fax 



Jeannette Bobst 

Public Health Services Manager 

Lane County Government 

135 E. 6th Avenue 

Eugene, OR 97401 

(503) 465-4013 

(503) 465-2455 Fax 



224 



Joyce L. Bollard, RN 

Nurse Manager and MCH Director 

Norfolk Department of Public Health 

401 Colley Avenue 

Norfolk, VA 23507 

(804) 683-2785 

(804) 683-8878 Fax 



Karen K Butler, MPH 

Commissioner of Health 

Cleveland Department of Public Health 

1925 St. Clair Avenue 

Cleveland, OH 44114 

(216) 664-2324 

(216) 664-2197 Fax 



Nira Bonner, MD, MPH, FAAP 
Assistant Commissioner of Health 
Baltimore City Health Department 
303 E. Fayette St. 2nd Floor 
Baltimore, MD 21202 
(410) 727-1834 
(410) 727-2722 Fax 



Gary C Butts, MD 

Deputy Commissioner, FHS 

City of New York Department of Health 

1 25 Worth Street, Suite 338 

New York, NY 10013 

(212) 984-5331 

(212) 984-0472 Fax 



Nancy L. Bowen, MD, MPH 

Chief, MCH 

San Diego County Health Department 

3851 Rosecrans St., 

PO Box 85222, MS P511F 

San Diego, CA 92186-5222 

(619) 692-8808 

(619) 692-8827 Fax 



Loydene Cain, RN 

Program Admin, Women's Health Division 

City-County Health Department 

of Oklahoma County 

921 NE 23rd Street 

Oklahoma City, OK 73105 

(405) 427-4370 

(405) 427-3233 Fax 



Virginia Bowman, RN, MPH 

Chief, MCH Programs 

Allegheny County Health Department 

542 Forbes Avenue Suite 522 

Pittsburgh, PA 15219-2904 

(412) 355-5949 

(412) 355-3352 Fax 



Kathy Carson, RN 

Parent Child Health Manager 

Seattle-King County Health Department 

1 1 Prefontaine Place, Suite 500 

Seattle, WA 98104 

(206) 296-4677 

(206) 296-4679 Fax 



Mary E Bradley, RN, MS 
Maternal Child Health Specialist 
Madison Department of Public Health 
2713 E. Washington Avenue 
Madison, Wl 53704 
(608) 246-4524 
(608) 246-5619 Fax 



Brenda Coulehan, RN, MA 

Family Health Services Coordinator 

Memphis & Shelby County Health Department 

814 Jefferson Avenue 

Memphis, TN 38105 

(901) 576-7910 

(901) 576-7832 Fax 



Gayle Bridges Harris 

Director of Nursing 

Durham County Health Dept. 

414 East Main Street 

Durham, NC 27701 

(919)560-7700 

(919) 560-7740 Fax 



Nick U. Curry, MD, MPH 

Director of Public Health 

Fort Worth/Tarrant County Health Department 

1 800 University Drive, Room 230 

Fort Worth, TX 76107 

(817) 871-7201 

(817) 871-7335 Fax 



225 



Margaret Daly, MA 

Prenatal/Family Planning Division Head 

Wyandotte County Health Dept. 

619 Ann Avenue 

Kansas City, KS 66101 

(913) 573-6714 

(913) 573-6729 Fax 



Carole A. Douglas, RN, MPH 

Chief, Public Health Nursing Division 

Lincoln-Lancaster County Health Department 

2200 St. Mary's Avenue 

Lincoln, NE 68502 

(402) 441-8051 

(402) 441-8323 Fax 



Rick Davis 

Project Director 

Child and Family Health Services 

255 W. Exchange Street, # 15 

Akron, OH 44302 

(216) 258-8945 

(216) 258-3096 Fax 



Karin Duncan, RN, MSN 

Director, Maternal and Child Health 

Monroe County Department of Health 

1 1 1 Westfall Rd Caller 632 

Rochester, NY 14692 

(716) 274-6192 

(716) 274-6859 Fax 



Susan DeMontigny, MSN, MPH 

MCAH Coordinator 

San Joaquin County Public Health Services 

MCAH Division 

1601 E. Hazelton Avenue 

Stockton, CA 95205 

(209) 468-0329 

(209) 468-2072 Fax 



Edward P. Ehlinger, MD, MSPH 
Director, Personal Health Services 
Minneapolis Health Department 
250 South 4th Street 
Minneapolis, MN 55415 
(612) 673-2780 
(612) 673-3866 Fax 



Claude M. Dharamraj, MD 

Assistant Director 

Pinellas County Public Health Unit 

500 Seventh Avenue South 

St. Petersburg, FL 33701 

(813) 823-0401 

(813) 823-0568 Fax 



Beatrice L. Emory, RN, MPH 

Director of Nursing 

Knox County Health Department 

925 Cleveland Place 

Knoxville, TN 37917-7191 

(615) 544-41 14 

(615) 544-4295 Fax 



Susan Dirik 

Public Health Clinic Supervisor 

City of Mesquite Public Health Clinic 

1515 N. Galloway 

Mesquite, TX 75149 

(214) 613-0182 

(214) 216-6397 Fax 



Barbara Feyh 

Director, Community & Family Services 

Spokane County Health District 

W 1 101 College Avenue 

Spokane, WA 99201 

(509) 324-1617 

(509) 324-1507 Fax 



Donalda Dodson 

Manager, Public Health for Marion County 

Marion County Health Department 

3180 Center, NE 

Salem, OR 97301 

(503) 588-5357 

(503) 364-6552 Fax 



Shirley Fleming, RN, CMN, DrPH 

Deputy Commissioner, Pub HIth & Clin Services 

Chicago Department of Health 

333 South State Street, Room 2129A 

Chicago, IL 60604 

(312) 747-9815 

(312) 747-9739 Fax 



226 



George R. Flores, MD, MPH 

Health Officer and MCH Director 

Sonoma County Dept. of Health Services 

3313 Chanate Road 

Santa Rosa, CA 95404 

(707) 576-4700 

(707) 576-4694 Fax 



Donald R. Hagel, MD 

Director of Women's Health 

Duval County Public Health Division 

5322 Pearl St. 

Jacksonville, FL 32208 

(904) 630-3907 

(904) 354-3909 Fax 



Len Foster, MPA 

Deputy Director of Public Health 

Orange County Health Care Agency 

515 North Sycamore 

Santa Ana, CA 92701 

(714) 834-3882 

(714) 834-5506 Fax 



Judith Harper West, MPH 
Health Care Administrator 
Detroit Health Department 
1151 Taylor, Room 317C 
Detroit, Ml 48202 
(313) 876-4228 
(313) 876-0906 Fax 



Karen Furst 

MCH Director 

City of Berkeley 

2180 Milvia Street, 3rd Floor 

Berkeley, CA 94704 

(510) 644-7744 

(510) 644-6494 Fax 



Anna Hawkins, RN 

Supervisor, LBW Program/High Risk Case Mgt 

Dallas Dept of Health and Human Services 

2922 Martin Luther King, Jr. Blvd. 

MLK Center Medical Building 

Dallas, TX 75215 

(214) 670-8777 

(214) 670-8501 Fax 



Hazel Gaines, RN, MS 

Perinatal Division Director 

Hinds County Health Department 

P.O. Box 1700 

Jackson, MS 39215-1700 

(601) 960-7464 

(601) 960-7480 Fax 



Mary L. Hennrich 

Director, Primary Care Clinical Services 

Multnomah County Health Division 

426 SW Stark St. 8th Floor 

Portland, OR 97204 

(503) 248-3674 

(503) 248-3676 Fax 



Margaret E. Gier, RNC, MS 
Manager, Women's Health Programs 
Tri-County Health Department 
7000 E. Belleview 
Englewood, CO 801 1 1 
(303) 220-9200 
(303) 220-9208 Fax 



Kathy Holley 

Director of Nursing 

Central District Health Dept. 

707 N. Armstrong Place 

Boise, ID 83704 

(208) 327-8580 

(208) 327-8500 Fax 



Julie Grisham 

MCAH Director, Santa Clara Co. 

Public Health Dept. 

976 Lanzen Ave. 

San Jose, CA 95126 

(408) 299-5036 

(408) 287-9793 Fax 



Diane Holmgren 

Health Administration Manager 

Saint Paul Public Health 

555 Cedar Street 

Saint Paul, MN 55101 

(612) 292-7712 

(612) 222-2770 Fax 



227 



Tracy Hudgins 

Asst Dir, Pub Health Nursing/Clinical Services 

Jefferson County Dept. of Health 

1400 6th Avenue South 

Birmingham, AL 35202 

(205) 930-1575 

(205) 930-1575 Fax 



Leslie J. Lawson, MPH, MPA 
Manager, Women's Health Services 
Jefferson County Health Dept. 
400 East Gray St. Box 1 704 
Louisville, KY 40201-1704 
(502) 625-6661 
(502) 625-5734 Fax 



Catherine Jackson 

Maternal and Child Health Director 

New Haven Health Department 

54 Meadow Street, Gateway Center 

New Haven, CT 06519 

(203) 777-5950 

(203) 772-7521 Fax 



Susan M. Lieberman 
Interim Director, MCH 
Philadelphia Dept. of Public Health 
500 S. Broad Street 
Philadelphia, PA 19146 
(215) 685-6827 
(215) 875-5906 Fax 



Lise Jankowski, MS, RN 

Assistant Director of Nursing 

Peoria City/County Health Department 

2116 North Sheridan Road 

Peoria, IL 61604 

(309) 679-6011 

(309) 685-3312 Fax 



Deborah J. Lutjen 

MCH Coordinator 

Douglas County Health Department 

Civic Center 401, 1819 Farnam Street 

Omaha, NE 68183 

(402) 444-7209 

(402) 444-6267 Fax 



Sally Kennedy 

Director of Nursing Services 

New Mexico Dept. of Health 

PO Box 25846 

Albuquerque, NM 87125 

(505) 841-4125 

(505) 841-4826 Fax 



Barbara L. Maack 

Nurse Manager, Public Health Nursing 

Pima County Health Dept. 

6920 E. Broadway Blvd., Ste E 

Tucson, AZ 85710 

(602) 298-3888 

(602) 721-8448 Fax 



Suzanne Kirkham, MPA 

Associate Division Director 

Salt Lake City, County Health Dept. 

2001 South State Street 53820 

Salt Lake City, UT 84190-2150 

(801) 468-2726 

(801) 468-2737 Fax 



Carole McConnell, MSN, MPH 
MCH Program Manager 
Anchorage Health Department 
P.O. Box 196650 
Anchorage, AK 99519-6650 
(907) 343-6128 
(907) 258-6379 Fax 



Juanita Larkins 

Acting Director 

Newark HHS/Division of Community Health 

110 William Street 

Newark, NJ 07102 

(201) 733-7590 

(201) 733-5949 Fax 



Betty B. McLain, RN 

Nursing Supervisor 

El Paso County Health Department 

501 North Foote Avenue 

Colorado Springs, CO 80909 

(719) 578-3212 

(719) 578-3214 Fax 



228 



Paul Melinkovich, MD 

Medical Director, Denver School-Based Health 

Denver City/County Health Department 

777 Bannock Street 

Denver, CO 80204-4507 

(303) 436-7433 

(303) 436-5113 Fax 



Anita Muir 

Deputy Administrator 

Division of Public Health 

2055 Limestone Road, Suite 300 

Wilmington, DE 19802 

(302) 995-8634 

(302) 995-8616 Fax 



Bruce P. Miller, MPH 

Director 

Community Health Services 

Ingham County Health Department 

5303 S. Cedar Street, PO Box 30161 

Lansing, Ml 48909 

(517) 887-7433 

(517) 887-4310 Fax 



Jenifer Murray, RN, MPH 

MCH Program Supervisor 

Genesee County Health Department 

1 1 5 E. Pierson Road 

Flint, Ml 48502-1540 

(810) 785-5263 

(810) 785-9675 Fax 



Sharon Mitchell 
Project Director 
Gary Health Department 
1 1 45 West 6th Avenue 
Gary, IN 46402 
(219) 882-1113 
(219) 882-8213 Fax 



Karen Nelson 

Baltimore City Health Department 

303 E. Fayette St. 2nd Floor 

Baltimore, MD 21202 

(410) 396-1834 

(410) 727-2722 Fax 



Cleopathia Moore, PHN, MPA 

Director, MCH 

Stanislaus County Health Department 

2030 Coffee Road, C-4 

Modesto, CA 95355 

(209) 558-7400 

(209) 558-8315 Fax 



Janine O'Hara, MD, MPH 

City of Long Beach 

Dept. of Health & Human Services 

2525 Grand Avenue 

Long Beach, CA 90815 

(310) 570-4159 

(310) 570-4049 Fax 



Regina L. Moore, RN 

MCH Administrator 

Lexington/Fayette County Health Department 

650 Newtown Pike 

Lexington, KY 40508 

(606) 288-2431 

(606) 288-7510 Fax 



Beverly Parkman 

Pub HIth Nursing Supervisor-Perinatal Programs 

Akron Health Department 

655 N. Main Street 

Akron, OH 44310 

(216) 375-2369 

(216) 375-2154 Fax 



Peter J. Morris, MD, MPH 

Deputy Health Director 

Wake County Department of Health 

PO Box 1 4049 

Raleigh, NC 27620 

(919) 250-3813 

(919) 250-3984 Fax 



Alice Pita, MD 

Project Director, Health Education and Literacy 

City of Dallas DHHS 

2922 B Martin Luther King, Jr. Blvd. 

Dallas, TX 75215 

(214) 670-8266 

(214) 670-8501 Fax 



229 



Elvin N. Plank, RN, MPA 

Administrator, MCH 

Marion County Division of Public Health 

3838 North Rural Street, 8th Floor 

Indianapolis, IN 46204 

(317) 541-2347 

(317) 541-2307 Fax 



Mary M. Sappenfield 

Nursing Director, Child Health Division 

Guilford County Dept. of Public Health 

1 100 E. Wendover Ave. 

Greensboro, NC 27405 

(910) 373-3273 

(910) 333-6603 Fax 



Martha Quiroga, RNC, MSN 

Coordinator for Care Managennent Services 

El Paso City/County Health District 

222 S. Campbell Street 

El Paso, TX 79901-2897 

)915) 543-3547 

(915) 543-3541 Fax 



Melissa Selbst, MPH, CHES 

Manager, Office of Women & Children's Health 

Maricopa County Department of Public Health 

1825 East Roosevelt Street 

Phoenix, AZ 85006 

(602) 506-6781 

(602) 506-6885 Fax 



Carol Regel 

Supervisor, Community Health Nursing Program 
Missoula City/County Health Department 
301 W. Adier 
Missoula, MT 59802 
(406) 523-4750 
(406) 523-4781 Fax 



Eleni D. Sfakianaki, MD, MSPH 
Medical Executive Director 
HRS - Dade County Health Unit 
1350 NW 14th Street 
Miami, FL 33125 
(305) 324-2401 
(305) 324-5959 Fax 



Grace Rutherford 

Medical Coordinator 

City of Garland Health Dept. 

PO Box 469002, 1720 Commerce 

Garland, TX 75046-9002 

(214) 205-3460 

(214) 205-3505 Fax 



Lillian Shirley 

Director, Maternity Services 

Boston Department of Health and Hospitals 

81 8 Harrison Ave. 

Boston, MA 02 11 8 

(617) 534-5515 

(617) 534-3999 Fax 



Lisa Sanford, RN, MPH 

Chief, Preventive Health Services 

City of Laredo Health Department 

2600 Cedar Avenue, PO Box 2337 

Laredo, TX 78044-2337 

(210) 723-2051 

(210) 726-2632 Fax 



Carolyn B. Slack, MS, RN 

Administrator, Family Health Services 

Columbus Health Department 

181 South Washington Blvd, Room 208 

Columbus, OH 43215-4096 

(614) 645-6424 

(614) 645-5888 Fax 



N. Beatrice Sangweni 

Acting Director 

New York City Department of Health 

125 Worth Street, Box 45C 

New York, NY 10013 

(212) 788-4334 

(212) 721-4326 Fax 



Frederick L. Steed 

Supervisor, Bur of Primary Health Care Services 

Montgomery County Health District 

451 West Third Street 

Dayton, OH 45422 

(513) 225-4966 

(513) 496-3071 Fax 



230 



Betty J. Thompson, RN, CS 
Director, MCH Programs 
Metropolitan Health Department 
311 23rd Avenue North 
Nashville, TN 37203 
(615) 340-5655 
(615) 340-5665 Fax 



Magda Torres Jusino, MD, MPH 
MCH Director, MCH Program 
San Juan Health Department 
Apartado 21405, Rio Piedras Station 
Rio Piedras, PR 00928 
(809) 751-6975 
(809) 764-5281 Fax 



Dannie M. Thompson, MD 
PN/FP, MCH Consultant 
Wyandotte Co. Health Dept 
619 Ann Avenue 
Kansas City, KS 66101 
(913) 573-6714 
(913) 573-6729 Fax 



Linda Velasquez, MD, MPH 
Director, Child Health Programs 
Family Health Programs, MCH 
241 N. Figueroa St., Room 306 
Los Angeles, CA 90012 
(213) 240-8090 
(213) 893-0919 Fax 



Meredith Tipton, MPH 

Director 

City of Portland Public Health Division 

389 Congress Street Room 307 

Portland, ME 04101 

(207) 874-8300 x8784 

(207) 874-8649 Fax 



Lisa Yenny 

Deputy Project Director 
City of Cleveland - Dept. 
1925 St. Clair Ave, 
Cleveland, OH 44114 
(216) 664-4620 
(216) 664-2197 Fax 



of Public Health 



Patricia Tompkins, RN, MS 

Chief, Office of Maternal and Child Health 

Comm of Public Health, DC Dept Hum Serv 

613 G Street, NW, Suite 638 

Washington, DC 20001 

(202) 727-0393 

(202) 727-0622 Fax 



Elizabeth A. Zelazek, RN, MS 

Public Health Nursing Manager 

City of Milwaukee Health Department 

841 N Broadway Room 228 

Milwaukee, Wl 53202 

(414) 278-3606 

(414) 286-8174 Fax 



231 



speakers 



Ellen Anderson 

State Senator 

State of Minnesota Legislative Connmittee on 

Children, Youth and Family 

G-27 State Capitol 

St. Paul, MN 55155 

(612) 296-5527 

(612) 296-6511 Fax 



C.M.G. Buttery, MD, MPH 

Health Director 

Richmond City Health Department 

600 East Broad Street 

Suite 629 

Richmond, VA 23219 

(804) 780-4211 

(804) 783-8257 Fax 



Maribeth Badura 

Deputy Chief, ROB, Division of Healthy Start 

Maternal and Child Health Bureau 

Parklawn Building, Room 11A-13 

5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-8283 

(301) 594-0186 Fax 



Gary C Butts, MD 

Deputy Commissioner, FHS 

City of New York Department of Health 

125 Worth Street 

Suite 338 

New York, NY 10013 

(212) 788-5331 

(212) 984-0472 Fax 



Lou Kelley Brewer 

Assistant Health Director 

Wake County Department of Health 

PO Box 14049 

Raleigh, NC 27620-4049 

(919) 250-4632 

(919) 250-3984 Fax 



Gilberto Chavez, MD, MPH 
Chief, MCH Epidemiology Section 
California Department of Health 
714 P Street, Room 476 
Sacramento, CA 95814 
(916) 657-0324 
(916) 657-0796 Fax 



Betty Bumpers 

Co-Founder 

Every Child By Two 

705 8th Street, SE, Suite 400 

Washington, DC 20003 

(202) 544-0808 

(202) 544-9251 Fax 



Mike Christenson 

Executive Director 

Medica Foundation 

Mail Route 71 10, P.O. Box 1587 

Minneapolis, MN 55440-1587 

(612) 936-1970 

(612) 936-6858 Fax 



Karen K Butler, MPH 

Commissioner of Health 

Cleveland Department of Public Health 

1925 St. Clair Avenue 

Cleveland, OH 44114 

(216) 664-2323 

(216) 664-2197 Fax 



Brenda Coulehan, RN, MA 

Family Health Services Coordinator 

Memphis & Shelby County Health Department 

814 Jefferson Avenue 

Memphis, TN 38105 

(901) 576-7910 

(901) 576-7832 Fax 



232 



Donalda Dodson 

Manager, Public Health for Marlon County 

Marion County Health Department 

3180 Center, NE 

Salem, OR 97301 

(503) 588-5357 

(503) 364-6552 Fax 



Margaret E. Gier, RNC, MS 
Manager, Women's Health Programs 
Tri-County Health Department 
7000 E. Belleview 
Englewood, CO 801 1 1 
(303) 220-9200 
(303) 220-9208 Fax 



Karin Duncan, RN, MSN 
Director, Maternal and Child Health 
Monroe County Department of Health 
1 1 1 Westfall Rd Caller 632 
Rochester, NY 14692 
(716) 274-6192 
(716) 274-6859 Fax 



Julia Graham Lear, PHD 
Director, Making the Grade 
George Washington University 
1 350 Connecticut Avenue 
Washington, DC 20036 
(202) 466-3396 
(202) 466-3467 Fax 



Edward P. Ehlinger, MD, MSPH 
Director, Personal Health Services 
Minneapolis Health Department 
250 South 4th Street 
Minneapolis, MN 55415 
(612) 673-2780 
(612) 673-3866 Fax 



David A. Hamburg 

President 

Carnegie Corporation of New York 

437 Madison Avenue 

New York, NY 10022 

(212) 371-3200 



M. Joycelyn Elders, MD 

Surgeon General 

U.S. Public Health Service 

Department of Health and Human Services 

200 Independence Avenue SW, Room 736E 

Washington, DC 20201 

(202) 690-6467 



Margaret A. Hamburg, MD 

Commissioner 

New York City Dept. of Health 

1 25 Worth Street 

New York, NY 10025 

(212) 788-5261 

(212) 964-0472 Fax 



Shirley Fleming, RN, CMN, DrPH 

Deputy Commissioner, Pub HIth & Clin Serv 

Chicago Department of Health 

333 South State Street, Room 2129A 

Chicago, IL 60604 

(312) 747-9815 

(312) 747-9739 Fax 



Maxine D. Hayes, MD, MPH 

Assistant Secretary 

Department of Health 

Division Community & Family Health 

PO Box 47880 

Olympia, WA 98504-7880 

(206) 753-7021 

(206) 586-7868 Fax 



Len Foster, MPA 

Deputy Director of Public Health 

Orange County Health Care Agency 

515 North Sycamore 

Santa Ana, CA 92701 

(714) 834-3882 

(714) 834-5506 Fax 



Mary L. Hennrich 

Director, Primary Care Clinical Services 

Multnomah County Health Division 

426 SW Stark St. 8th Floor 

Portland, OR 97204 

(503) 248-3674 

(503) 248-3676 Fax 



233 



Catherine Hess, MSW 

Executive Director 

Association of MCH Programs 

1350 Connecticut Avenue, Suite 803 

Washington, DC 20036 

(202) 775-0436 

(202) 775-0061 Fax 



Yusef Mgeni 

Executive Director 

Urban Coalition 

2610 University Ave. West, Suite 201 

St. Paul, MN 55114 

(612) 348-8550 

(612) 348-2533 Fax 



Jillian Jacobellis, CNM, MS 

Former Dir, Policy, Planning, Prog Devel 

Salt Lake City/County Health Department 

2001 S. State St. Suite 3800 

Salt Lake City, UT 84190-2150 

(801) 468-2724 

(801) 468-2646 Fax 



Peter J. Morris, MD, MPH 

Deputy Health Director 

Wake County Department of Health 

PO Box 14049 

Raleigh, NC 27620 

(919) 250-3813 

(919) 250-3984 Fax 



Marlene N. Kelley, MD 

Administrator 

Ambulatory Health Care Administration 

1660 L Street NW 

Washington, DC 20036 

(202) 673-6670 

(202) 673-2138 Fax 



Audrey H. Nora, MD, MPH 

Director 

Maternal and Child Health Bureau 

HRSA/DHHS, Parklawn Building, Room 18-05 

5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-2170 

(301) 443-1797 Fax 



Cara Krulewitch, PhD, RN 
Perinatal Epidemiologist 
CDC/NCCDHP/DRH/PIHB 
1660 L Street, NW, Suite 907 
Washington, DC 20036 
(202) 673-4551 
(202) 727-9021 Fax 



Walter Orenstein, MD 

Director, National Immunization Program 

Centers for Disease Control and Prevention 

1600 Clifton Road, Mail Stop E05 

Atlanta, GA 30333 

(404) 639-8200 

(404) 639-8626 Fax 



Beth A. Macke, PhD 

Epidemiologist 

Centers for Disease Control and Prevention 

4770 Buford Highway, NE (K23) 

Atlanta, GA 30341-3724 

(404) 488-5628 

(404) 488-562 Fax 



Gary Oxman, MD, MPH 

Health Officer 

Multnomah County Health Dept. 

476 SW Street, 8th Floor 

Portland, OR 97204 

(503) 248-3674 

(503) 248-3676 Fax 



Paul Melinkovich, MD 

Medical Director, Denver School-Based Health 

Denver City/County Health Department 

777 Bannock Street 

Denver, CO 80204-4507 

(303) 436-7433 

(303) 436-5113 Fax 



Magda G. Peck, ScD, PA 
Executive Director, CityMatCH 
University of Nebraska Medical Center 
Department of Pediatrics 
600 South 42nd Street 
Omaha, NE 68198-2170 
(402) 559-8323 
(402) 559-5355 Fax 



234 



Mary Peoples-Sheps 

Associate Professor 

UNC School of Public Health 

CB 7400 Rosenau Hall 

Chapel Hill, NC 27544-7400 

(919) 966-6878 

(919) 966-7141 Fax 



Hugh F. Stallworth, MD 

Health Officer/Director of Public Health 

Orange County Health Care Agency 

515 N. Sycamore St. 

Santa Ana, CA 92701 

(714) 834-3155 

(714) 834-5506 Fax 



Karen L. Power, MPH 

Director, Office of Research & Health Statistics 

Boston Department of Health and Hospitals 

1010 Massachusetts Avenue 

Boston, MA 

(617) 534-5358 

(617) 534-5358 Fax 



Giro V. Sumaya, MD, MPHTM 

Administrator 

Health Resources and Services Administration 

Parklawn BIdg. 14-05, 5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-2216 

(301) 443-1246 Fax 



Grace Rutherford 

Medical Coordinator 

City of Garland Health Dept. 

PO Box 469002, 1720 Commerce 

Garland, TX 75046-9002 

(214) 205-3460 

(214) 205-3505 Fax 



Meredith Tipton, MPH 

Director 

City of Portland Public Health Division 

389 Congress Street Room 307 

Portland, ME 04101 

(207) 874-8300 x8784 

(207) 874-8649 Fax 



Lisa Sanford, RN, MPH 

Chief, Preventive Health Services 

City of Laredo Health Department 

2600 Cedar Avenue, PO Box 2337 

Laredo, TX 78044-2337 

(210) 723-2051 

(210) 726-2632 Fax 



Deborah von Zinkernagel 

Health Policy Anafyst 

Committee on Labor and Human Resources 

428 Dirksen Senate Office Building 

Washington, DC 20510 

(202) 224-5880 

(202) 224-3533 Fax 



Ken Schoendorf, MD, MPH 
DHHS/Public Health Services/CDC 
Division of Analysis 
National Center for Health Statistics 
6525 Belcrest Road, 7th Floor, Room 790 
Hyattsville, MD 20782 
(301) 436-5975 
(301) 436-8459 Fax 



Martin Wasserman, MD, JD 

Director 

Prince George's County Health Department 

3003 Hospital Drive 

Cheverly, MD 20785 

(301) 386-0279 

(301) 386-3531 Fax 



Carolyn B. Slack, MS, RN 

Administrator, Family Health Services 

Columbus Health Department 

181 South Washington Blvd., Room 208 

Columbus, OH 43215-4096 

(614) 645-6424 

(614) 645-5888 Fax 



Sheila J. Webb, RN, MS 

Deputy Director of Health 

City of New Orleans - Health Dept. 

1300 Perdido Street, Rm. 8E13 City Hall 

New Orleans, LA 70112 

(504) 565-6906 

(504) 565-6916 Fax 



235 



Donald E. Williamson, MD 
Health Officer 
Health Administration 
434 Monroe Street 
Montgomery, AL 36130 
(205) 613-5200 
(205) 240-3387 Fax 



Elizabeth A. Zelazek, RN, MS 

Public Health Nursing Manager 

City of Milwaukee Health Department 

841 N Broadway Room 228 

Milwaukee, Wl 53202 

(414) 278-3606 

(414) 286-8174 Fax 



236 



Co-Sponsor Representatives 



Leslie Dunne 

Program Associate 

Healthy Mothers, Healthy Babies 

409 1 2th Street, SW 

Washington, DC 20024-2188 

(202) 863-258 

(202) 484-5107 Fax 



John E. Kyle 

Project Director, Children and Families in Cities 

National League of Cities 

1301 Pennsylvania Ave., NW 

Washington, DC 20004 

(202) 626-3030 

(202) 626-3043 Fax 



Amy Fine, BSN, MPH 

Senior Policy Analyst 

Association of MCH Programs 

1 350 Connecticut Avenue, Suite 803 

Washington, DC 20015 

(202) 775-0436 

(202) 775-0061 Fax 



William Randolph, MS 

Assoc. Dir., New Initiaves 

Chapter Program Services 

March of Dimes Birth Defects Foundation 

1275 Mamaroneck Ave. 

White Plains, NY 10605 

(914) 997-4461 

(914) 428-8203 Fax 



Marissa Fuller, MHS 
Senior Staff Assistant 
National Governors' Association 
444 North Capitol St., Suite 267 
Washington, DC 20001 
(202) 624-5303 
(202) 624-5313 Fax 



Cynthia Scott 

Director of Community Services 

March of Dimes Birth Defects Foundation 

2700 S. Quincy Street, #220 

Arlington, VA 22206 

(703) 824-0111 

(703) 578-4928 Fax 



Grace Gianturco, RN, MPH 

Director, Personal Health Programs & Policies 

NACCHO 

440 First Street, NW, Suite 500 

Washington, DC 20001 

(202) 783-5550 

(202) 783-1583 Fax 



Margaret Skelley 

Director of Public Health Programs 

Assoc of State & Territorial Health Officials 

415 Second Street, NE, Suite 200 

Washington, DC 20002 

(202) 546-5400 

(202) 544-9349 Fax 



Catherine Hess, MSW 

Executive Director 

Association of MCH Programs 

1 350 Connecticut Avenue, Suite 803 

Washington, DC 20036 

(202) 775-0436 

(202) 775-0061 Fax 



237 



Guests 



Dorothy Allbritten, MSN, MPH 

Director, Child Health Analysis 

NACHRI 

401 Wythe Street 

Alexandria, VA 22314 

(703) 684-1355 

(703) 684-1589 Fax 



Gail Davis, MA, MPH, LCSW 

Public Health Analyst, MCHB/Healthy Start 

Parklawn Building, Room 11A-13 

5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-8283 

(301) 594-0186 Fax 



Molly Anthony 

Child Health Program 

NACHRI 

401 Wythe Street 

Alexandria, VA 22314 

(703) 684-1355 

(703) 684-1589 Fax 



Harriet Dichter, JD 

Director, Maternal & Child Health 

Philadelphia Department of Health 

500 South Broad Street 

Philadelphia, PA 19146 

(215) 875-5927 

(215) 875-5906 Fax 



Cheryl Austein Casnoff, MPH 

Director, Public Health Policy 

Office of Planning and Evaluation 

200 Independence Ave, S.W. Room 432E 

Washington, DC 20201 

(202) 690-6051 

(202) 401-7321 Fax 



Jane S. Durch 

Program Officer, Institute of Medicine 

lOM - FO 31 18 

2101 Constitution Avenue NW 

Washington, DC 20418 

(202) 334-2069 

(202) 334-2939 Fax 



Dianne Cairnes 

Maternal and Child Health Bureau 

Parklawn Building, Room 1 8A-30 

5600 Fishers Lane 

Rockville, MD 

(301) 443-2250 



Michael Fishman, MD 

Assistant Director, Division of Maternal, Infant, 

Child and Adolescent Health, MCHB 

Parklawn BIdg. 18A-30, 5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-2250 

(301) 443-1296 Fax 



Stephanie J. Cook McDaniel 

Consultant, Public Health Service 

Division of Healthy Start 

5600 Fisher Lane, Room 1 1A0S 

Rockville, MD 20735 

(301) 443-8284 

(301) 594-0186 Fax 



Carol Galaty 

Director, Office of Program Development 

Maternal and Child Health Bureau 

Parklawn BIdg 1 1A-22, 5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-2778 

(301) 594-0186 Fax 



Robert J. Cullen, MHA 

Director, Maternal and Child Health 

Prince George's County Health Dept. 

3003 Hospital Drive 

Cheverly, MD 

(301) 386-0166 

(301) 322-5425 Fax 



Lucy D. Hackney 
Health Director 
Children's Defense Fund 
25 E Street, NW 
Washington, DC 20001 
(202) 662-3559 
(202) 662-3560 Fax 



238 



Cleo Hancock, MSW 
Program Analyst OPD, MCHB 
Parklawn Building, Room 11A-22 
5600 Fishers Lane 
Rockville , MD 20857 
(301) 443-2778 
(301) 443-1797 Fax 



Ann Koontz, DrPH, CNM 

Chief, Perinatal/Women's Health Branch, MCHB 

Parklawn Building, Room 18A-39 

5600 Fishers Lane 

Rockville, MD 20857 

(301)443-5720 

(301) 443-1296 Fax 



Martha Haynes 

Public Health Analyst 

Division of a Healthy Start, MCHB 

Room 11A-05, 5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-8283 

(301) 594-0186 Fax 



Jeffrey Koshel 

Senior Consultant 

Robert Wood Johnson Foundatoin 

Washington, DC 

(202) 362-1036 

(202) 362-8155 Fax 



Mary K. Hebert, MA 

Manager, Prevention Leadership Forum 

Washington Business Group on Health 

777 North Capitol Street, NE, Suite 800 

Washington, DC 20008 

(202) 408-9320 

(202) 408-9332 Fax 



Janis Lambert 

Field Coordinator, Every Child By Two 

705 8th Street, SE, Suite 400 

Washington, DC 20003 

(202) 544-0808 

(202) 544-9751 Fax 



Laura Kavanagh, MPP 

Director, Division of Education 

National Center for Education in MCH 

Georgetown University 

2000 Fifteenth Street North, Suite 701 

Arlington, VA 22201 

(703) 524-7802 

(703) 524-9335 Fax 



David B. Maglott, MHA 

Evaluation Officer 

Office of Program Development, MCHB 

Parklawn Building, 11A-22 

5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-2778 

(301) 594-0186 Fax 



Woodie Kessel, MD, MPH 
Director, DSES, MCHB 
Parklawn Building, Room 18A-55 
5600 Fishers Lane 
Rockville, MD 20857 
(301) 443-2340 
(301) 443-4842 Fax 



Rochelle Mayer, EdD 

Director 

National Center for Education in MCH 

Georgetown University 

2000 Fifteenth Street North, Suite 701 

Arlington, VA 22201 

(703) 524-7802 

(703) 524-9335 Fax 



Michele Kiely, DrPH 
Epidemiologist, MCHB 
Parklawn Building, Room 1 8A-55 
5600 Fishers Lane 
Rockville, MD 20857 
(301) 443-2340 
(301) 443-4842 Fax 



Jessica Merron 
Program Associate 
Pew Charitable Trusts 
2005 Market St., 17th Floor 
Philadelphia, PA 19103 
(215) 575-4862 
(215) 575-4939 Fax 



239 



Elena Nightingale, MD, MPH 
Special Advisor to the President, 
Senior Program Officer 
Carnegie Corporation of New York 
2400 N St., NW, Sixth Floor 
Washington, DC 20037 
(202) 429-7979 



Lynn Squire 
Legislative Officer, OPD 
Maternal and Child Health Bureau 
Parklawn Building, Room 11A-22 
5600 Fishers Lane 
Rockville, MD 20857 
(301) 443-2778 
(301) 594-0186 Fax 



Susan V Smith, MPA 
Assistant to the President 
Carnegie Corporation of New York 
437 Madison Avenue 
New York, NY 10022 
(212) 371-3200 
(212) 753-0395 Fax 



Michael A. Stoto, PhD 

Director, Division of Health Promotion & 

Disease Prevention 

Institute of Medicine 

2101 Constitution Avenue, NW 

Washington, DC 20418 

(202) 334-2383 

(202) 334-2939 Fax 



Karen Smith Thiel Raykovich 

Director, Healthy Start Evaluation 

Health Resources & Services Administration 

5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-7718 

(301) 443-9270 Fax 



Phyllis E. Stubbs, MD, MPH 
Chief, Infant and Child Health Branch 
Maternal and Child Health Bureau 
Parklawn Building, Room 18A-39 
5600 Fishers Lane 
Rockville, MD 20857 
(301) 443-6600 
(301) 443-4842 Fax 



Lynn Spector, MPA 

Public Health Analyst 

Maternal and Child Health Bureau 

Parklawn Building, Room 18A-38 

5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-5720 

(301) 443-1296 Fax 



Peter C. van Dyck, MD, MPH 

Medical Officer 

Maternal and Child Health Bureau 

Parklawn Building, Room 18-20 

5600 Fishers Lane 

Rockville, MD 20857 

(301) 443-2204 

(301) 443-1797 Fax 



240 



Conference Staff 



CityMatCH 



NCEMCH 



Harry W Bullerdiek, MPA 
Project Coordinator, CityMatCH 
Department of Pediatrics, UNMC 
800 South 42nd Street 
Omaha, NE 68198-2170 
(402) 559-5642 
(402) 559-5355 Fax 



Susana C. Eloy 

Senior Project Associate 

National Center for Education in MCH 

2000 Fifteenth Street North, Suite 701 

Arlington, VA 22201 

(703) 524-7802 

(703) 524-9335 Fax 



Elice D. Hubbert, MPA 
Project Coordinator, CityMatCH 
Department of Pediatrics, UNMC 
600 South 42nd Street 
Omaha, NE 68198-2170 
(402) 559-5640 
(402) 559-5355 Fax 



Jennifer M. Kehoe 

Project Associate 

National Center for Education in MCH 

2000 15th Street North, Suite 701 

Arlington, VA 22201 

(703) 524-7802 

(703) 524-9335 Fax 



Chris Kerby, MPA 

Project Coordinator, CityMatCH 

Department of Pediatrics, UNMC 

600 S. 42nd Street 

Omaha, NE 68198-2170 

(402) 55907808 

(402) 559-5355 Fax 



Kate Ryder 

Project Associate 

National Center for Education in MCH 

2000 Fifteenth Street North, Suite 701 

Arlington, VA 22201 

(703) 524-7802 

(703) 524-9335 Fax 



Magda G. Peck, ScD, PA 
Executive Director, CityMatCH 
Department of Pediatrics, UNMC 
600 South 42nd Street 
Omaha, NE 68198-2170 
(402) 559-5138 
(402) 559-5355 Fax 



Becky Selengut 

Project Associate 

National Center for Education in MCH 

2000 15th Street North, Suite 701 

Arlington, VA 22201 

(703) 524-7802 

(703) 524-9335 Fax 



Joan Rostermundt 

Administrative Technician, CityMatCH 

Department of Pediatrics, UNMC 

600 South 42nd Street 

Omaha, NE 68198-2170 

(402) 559-8323 

(402) 559-5355Fax 



Paula M. Sheahan 

Director of Outreach 

National Center for Education in MCH 

2000 Fifteenth Street North, Suite 701 

Arlington, VA 22201 

(703) 524-7802 

(703) 524-9335 Fax 



241 



CityMatCH Publications Order Form 

Please send one copy of the publication(s) indicated 
to the following person: 



Name: 

Title: 

Organization: 

Address: 

City/State/ZIP: 

Phone: 



FAX: 



D D084 What Works: 1 990 Urban MCH Programs - A Directory of Maternal and Child 
Health Programs in Major Urban Health Departments ( out of print ) 

D E051 Building Urban MCH Connections: 1990 Urban Maternal and Child Health 

Leadership Conference ( out of print ) 

D F025 Forging an Urban MCH Partnership: Urban Maternal and Child Health 1991 

Leadership Conference ( out of print ) 

D G004 Strengthening Urban MCH Capacity: Highlights of the 1992 Urban Maternal 
and Child Health Leaership Conference 

D G005 What Works II: 1993 Urban MCH Programs - Maternal and Child Health 
Programs in Major Urban Health Departments: Focus on Immunizations ( out of 
print ) 

□ G084 Improving Urban MCH Linkages: Highlights of the 1993 Urban Maternal and 

Child Health Leadership Conference 

H038 Changing the Rules: Medicaid Managed Care and MCH in U.S. Cities, 
CityMatCH Special Report 1 

□ H039 Effective Leadership During Times of Transition: Highlights of the 1 994 Urban 

Maternal and Child Health Leadership Conference 



Return this form to: 

NMCHC 

8201 Greensboro Drive, Suite 600 

McLean, VA 22101 

(703) 821-8955 ext. 254 



242 



CityMatCH 



at the 

University of Nebraska Medical Center 

Department of Pediatrics 

600 South 42nd Street 

P.O. Box 982170 

Omaha, Nebraska 68198-2170 

Office (402) 559-8323 

Fax (402) 559-5355